You are here

  • Home
  • Archive
  • Volume 2, Issue 2
  • Provider-initiated delivery, late preterm birth and perinatal mortality: a secondary analysis of the WHO multicountry survey on maternal and newborn health

Article Text

Article menu

Download PDFPDF

XML
BMJ Global Health
Research
Provider-initiated delivery, late preterm birth and perinatal mortality: a secondary analysis of the WHO multicountry survey on maternal and newborn health
  1. Naho Morisaki1,
  2. Xun Zhang2,
  3. Togoobaatar Ganchimeg3,
  4. Joshua P Vogel4,
  5. Joo Paulo Dias Souza4,
  6. Jose G Cecatti5,
  7. Maria Regina Torloni6,
  8. Erika Ota7,8,
  9. Rintaro Mori8,
  10. Suneeta Mittal9,
  11. Suzanne Tough10,
  12. Siobhan Dolan11,
  13. Michael S Kramer12
  1. 1 Department of Social Medicine, National Center for Child Health and Research, Setagaya-ku, Tokyo, Japan
  2. 2 Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
  3. 3 Department of Global Health Nursing, Faculty of Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
  4. 4 Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
  5. 5 Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
  6. 6 Evidence Based Healthcare post-graduate program, Universidade de Sao Paulo, Sao Paulo, Brazil
  7. 7 Global Health Nursing, Graduate School of Nursing Science, St Luke’s International University, Chuo-ku, Tokyo, Japan
  8. 8 Department of Health Policy, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
  9. 9 Department of Obstetrics and Gynecology, Fortis Memorial Research Institute Gurgaon, Gurgaon, Haryana, India
  10. 10 Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  11. 11 Department of Obstetrics and Gynecology and Womens Health, Albert Einstein College of Medicine / Montefiore Medical Center, New York, NY, USA
  12. 12 Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
  1. Correspondence to Dr Naho Morisaki; morisaki-n{at}ncchd.go.jp

Abstract

Introduction In high-income countries, a reduced clinical threshold for obstetric interventions such as labour induction (LI) and prelabour caesarean delivery (PLCD) has played a substantial role in increasing rates of late preterm births. However, the association between provider-initiated delivery and perinatal outcomes have not been studied in a multicountry setting including low-income and middle-income countries.

Methods 286 hospitals in 29 countries participated in the WHO Multi-Country Survey on Maternal and Newborn Health and yielded 2 52 198 singleton births of at least 34 weeks in 2010–2011. We used an ecological analysis based on generalised estimating equations under multilevel logistic regression to estimate associations between hospital rates of PLCD and LI with rates of late preterm birth (34–36 weeks), stillbirth and intrahospital early neonatal death, in relation to country development based on the Human Development Index (HDI).

Results Rates of LI were higher in hospitals from very high-HDI (median 10.9%) and high-HDI (11.2%) countries compared with medium-HDI (4.0%) or low-HDI (3.8%) countries. Rates of PLCD were by far the lowest in low-HDI countries compared with countries in the other three categories (5.1% vs 12.0%–17.9%). Higher rates of PLCD were associated with lower perinatal death rates (OR 0.87 (0.79, 0.95) per 5% increase in PLCD) and non-significantly with late preterm birth (1.04 (0.98, 1.10)) regardless of country development. LI rates were positively associated with late preterm birth (1.04 (1.01, 1.06)) regardless of country development and with perinatal death (1.06 (0.98, 1.15)) only in middle-HDI and low- HDI countries.

Conclusion PLCD was associated with reduced perinatal mortality and non-significantly with increased late preterm birth. LI was associated with increases in both late preterm birth and, in less-developed countries, perinatal mortality. Efforts to provide sufficient, but avoid excessive, access to provider-initiated delivery should be tailored to the local context.

  • Maternal health
  • Obstetrics
  • Cross-sectional survey

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjgh-2016-000204

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors MK and JV initiated the concept. MK, NM, TG designed the study. NM and XZ conducted the analysis, NM wrote the initial manuscript and MK provided oversight of the process. All authors critically reviewed data tables and the initial draft and approved of the final draft. NM had full access to all of the data in this study and take complete responsibility for the integrity of the data and the accuracy of the data analysis.

    • Competing interests None declared.

    • Patient consent Our article does not include personal medical information about an identifiable living individual.

    • Ethics approval WHO Ethical Review Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Aggregated data are available on request from authors.