![]() ![]() Coverage of effective interventions is low, however, and many opportunities are missed to provide quality care within existing health systems. Simple, affordable, and effective approaches are available for low-resource settings, including community-based strategies to increase skilled birth attendance, partograph use by frontline health workers linked to emergency obstetrical care services, task shifting to increase access to Cesarean delivery, and simplified neonatal resuscitation training (Helping Babies Breathe(SM)). Intrapartum-related neonatal deaths can be averted by a range of interventions that prevent intrapartum complications (eg, prevention and management of pre-eclampsia), detect and manage intrapartum problems (eg, monitoring progress of labor with access to emergency obstetrical care), and identify and assist the nonbreathing newborn (eg, stimulation and bag-mask ventilation). Conditions that increase the risk of intrauterine hypoxia-such as pre-eclampsia/eclampsia, obstructed labor, and low birth weight-are often more prevalent in low resource settings. Approximately 60 million annual births occur outside of health facilities, and most of these childbirths are without a skilled birth attendant. Almost all of these deaths are in low- and middle-income countries, where women frequently lack access to quality perinatal care and may delay care-seeking. ![]() Evidence-based strategies are urgently needed to reduce the burden of intrapartum-related deaths particularly in low- and middle-income settings where 60 million women give birth at home.Įach year, 814,000 neonatal deaths and 1.02 million stillbirths result from intrapartum-related causes, such as intrauterine hypoxia. Almost 30 000 abstracts were searched and the evidence is evaluated and reported in the 6 subsequent papers.Each year the deaths of 2 million babies are linked to complications during birth and the burden is inequitably carried by the poor. The rural poor are at particular risk, and also have the lowest coverage of skilled care at birth. Maternal risk factors and delays in accessing care are critical contributors. Intrapartum-related neonatal mortality rates are 25-fold higher in the lowest income countries and intrapartum stillbirth rates are up to 50-fold higher. Most of the burden (99%) occurs in low- and middle-income countries. Reduction is crucial to meeting the fourth Millennium Development Goal (MDG), and is intimately linked to intrapartum stillbirths as well as maternal health and MDG 5, yet there is a lack of consensus on what works, especially in weak health systems.To clarify terminology for intrapartum-related outcomes to describe the intrapartum-related global burden to present current coverage and trends for care at birth and to outline aims and methods for this comprehensive 7-paper supplement reviewing strategies to reduce intrapartum-related deaths.Birth is a critical time for the mother and fetus with an estimated 1.02 million intrapartum stillbirths, 904 000 intrapartum-related neonatal deaths, and around 42% of the 535 900 maternal deaths each year. ![]() Intrapartum-related neonatal deaths (“birth asphyxia”) are a leading cause of child mortality globally, outnumbering deaths from malaria. ![]()
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