A New Look at Care in Pregnancy: Simple,

Effective Interventions for Neglected

Populations

Caglia, Jacquelyn et al.(2016)

Presented By: Judith Barcelona, RN,MAN

 BACKGROUND
Although this is beginning to change, the content of antenatal care has been
relatively neglected in safe-motherhood program efforts. This appears in part
to be due to an unwarranted belief that interventions over this period have far
less impact than those provided around the time of birth. In this par, we
review available evidence for 21 interventions potentially deliverable during
pregnancy at high coverage to neglected populations in low income countries,
with regard to effectiveness in reducing risk of: maternal mortality, newborn
mortality, stillbirth, prematurity and intrauterine growth restriction. Selection
was restricted to interventions that can be provided by non-professional
health auxiliaries and not requiring laboratory support.
Method

In this narrative review, we included relevant

Cochrane and other systematic reviews and did
comprehensive bibliographic searches. Inclusion
criteria varied by intervention; where available
randomized controlled trial evidence was
insufficient, observational study evidence was
considered. For each intervention we focused on
overall contribution to our outcomes of interest,
across varying epidemiologies.
 Results
In the aggregate, achieving high effective coverage for this set of
interventions would very substantially reduce risk for our outcomes of interest
and reduce outcome inequities. Certain specific interventions, if pushed to
high coverage have significant potential impact across many settings. For
example, reliable detection of pre-eclampsia followed by timely delivery
could prevent up to of newborn and stillbirth deaths and over 90% of
maternal eclampsia/pre-eclampsia deaths. Other interventions have potent
effects in specific settings: in areas of high P falciparum burden, systematic
use of insecticide-treated nets and/or intermittent presumptive therapy in
pregnancy could reduce maternal mortality by up to 10%, newborn mortality
by up to 20%, and stillbirths by up to 2530%. Behavioral interventions
targeting practices at birth and in the hours that follow can have substantial
impact in settings where many births happen at home: in such circumstances
early initiation of breastfeeding can reduce risk of newborn death by up to
20%; good thermal care practices can reduce mortality risk by a similar order
of magnitude.
Conclusions

Simple interventions delivered during pregnancy

have considerable potential impact on important
mortality outcomes. More programmatic effort is
warranted to ensure high effective coverage.
THANK YOU!