Provider-initiated delivery, late preterm birth and perinatal mortality: A secondary analysis of the WHO multicountry survey on maternal and newborn health

Naho Morisaki, Xun Zhang, Togoobaatar Ganchimeg, Joshua P. Vogel, Joo Paulo Dias Souza, Jose G. Cecatti, Maria Regina Torloni, Erika Ota, Rintaro Mori, Suneeta Mittal, Suzanne Tough, Siobhan M. Dolan, Michael S. Kramer

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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.

Original languageEnglish (US)
Article numbere000204
JournalBMJ Global Health
Volume2
Issue number2
DOIs
StatePublished - Jan 1 2017

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Perinatal Mortality
Premature Birth
Human Development
Induced Labor
Stillbirth
Infant Health
Maternal Health
Surveys and Questionnaires
Developing Countries
Obstetrics
Logistic Models
Parturition
Mortality

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Policy

Cite this

Provider-initiated delivery, late preterm birth and perinatal mortality : A secondary analysis of the WHO multicountry survey on maternal and newborn health. / Morisaki, Naho; Zhang, Xun; Ganchimeg, Togoobaatar; Vogel, Joshua P.; Souza, Joo Paulo Dias; Cecatti, Jose G.; Torloni, Maria Regina; Ota, Erika; Mori, Rintaro; Mittal, Suneeta; Tough, Suzanne; Dolan, Siobhan M.; Kramer, Michael S.

In: BMJ Global Health, Vol. 2, No. 2, e000204, 01.01.2017.

Research output: Contribution to journalArticle

Morisaki, N, Zhang, X, Ganchimeg, T, Vogel, JP, Souza, JPD, Cecatti, JG, Torloni, MR, Ota, E, Mori, R, Mittal, S, Tough, S, Dolan, SM & Kramer, MS 2017, 'Provider-initiated delivery, late preterm birth and perinatal mortality: A secondary analysis of the WHO multicountry survey on maternal and newborn health', BMJ Global Health, vol. 2, no. 2, e000204. https://doi.org/10.1136/bmjgh-2016-000204
Morisaki, Naho ; Zhang, Xun ; Ganchimeg, Togoobaatar ; Vogel, Joshua P. ; Souza, Joo Paulo Dias ; Cecatti, Jose G. ; Torloni, Maria Regina ; Ota, Erika ; Mori, Rintaro ; Mittal, Suneeta ; Tough, Suzanne ; Dolan, Siobhan M. ; Kramer, Michael S. / Provider-initiated delivery, late preterm birth and perinatal mortality : A secondary analysis of the WHO multicountry survey on maternal and newborn health. In: BMJ Global Health. 2017 ; Vol. 2, No. 2.
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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.",
author = "Naho Morisaki and Xun Zhang and Togoobaatar Ganchimeg and Vogel, {Joshua P.} and Souza, {Joo Paulo Dias} and Cecatti, {Jose G.} and Torloni, {Maria Regina} and Erika Ota and Rintaro Mori and Suneeta Mittal and Suzanne Tough and Dolan, {Siobhan M.} and Kramer, {Michael S.}",
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T2 - A secondary analysis of the WHO multicountry survey on maternal and newborn health

AU - Morisaki, Naho

AU - Zhang, Xun

AU - Ganchimeg, Togoobaatar

AU - Vogel, Joshua P.

AU - Souza, Joo Paulo Dias

AU - Cecatti, Jose G.

AU - Torloni, Maria Regina

AU - Ota, Erika

AU - Mori, Rintaro

AU - Mittal, Suneeta

AU - Tough, Suzanne

AU - Dolan, Siobhan M.

AU - Kramer, Michael S.

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N2 - 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.

AB - 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.

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