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Use of antenatal corticosteroids and tocolytic drugs in preterm births in 29 countries: an analysis of the WHO Multicountry Survey on Maternal and Newborn Health

(2014) LANCET. 384(9957). p.1869-1877
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Abstract
Background: Despite the global burden of morbidity and mortality associated with preterm birth, little evidence is available for use of antenatal corticosteroids and tocolytic drugs in preterm births in low-income and middle-income countries. We analysed data from the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS) to assess coverage for these interventions in preterm deliveries. Methods: WHOMCS is a facility-based, cross-sectional survey database of birth outcomes in 359 facilities in 29 countries, with data collected prospectively from May 1, 2010, to Dec 31, 2011. For this analysis, we included deliveries after 22 weeks' gestation and we excluded births that occurred outside a facility or quicker than 3 h after arrival. We calculated use of antenatal corticosteroids in women who gave birth between 26 and 34 weeks' gestation, when antenatal corticosteroids are known to be most beneficial. We also calculated use in women at 22-25 weeks' and 34-36 weeks' gestation. We assessed tocolytic drug use, with and without antenatal corticosteroids, in spontaneous, uncomplicated preterm deliveries at 26-34 weeks' gestation. Findings: Of 303 842 recorded deliveries after 22 weeks' gestation, 17 705 (6%) were preterm. 3900 (52%) of 7547 women who gave birth at 26-34 weeks' gestation, 94 (19%) of 497 women who gave birth at 22-25 weeks' gestation, and 2276 (24%) of 9661 women who gave birth at 35-36 weeks' gestation received antenatal corticosteroids. Rates of antenatal corticosteroid use varied between countries (median 54%, range 16-91%; IQR 30-68%). Of 4677 women who were potentially eligible for tocolysis drugs, 1276 (27%) were treated with bed rest or hydration and 2248 (48%) received no treatment. beta-agonists alone (n=346, 7%) were the most frequently used tocolytic drug. Only 848 (18%) of potentially eligible women received both a tocolytic drug and antenatal corticosteroids. Interpretation: Use of interventions was generally poor, despite evidence for their benefit for newborn babies. A substantial proportion of antenatal corticosteroid use occurred at gestational ages at which benefit is controversial, and use of less effective or potentially harmful tocolytic drugs was common. Implementation research and contextualised health policies are needed to improve drug availability and increase compliance with best obstetric practice.
Keywords
TRIAL, RESPIRATORY-DISTRESS, INFANTS

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MLA
Vogel, Joshua P, João Paulo Souza, A Metin Gülmezoglu, et al. “Use of Antenatal Corticosteroids and Tocolytic Drugs in Preterm Births in 29 Countries: An Analysis of the WHO Multicountry Survey on Maternal and Newborn Health.” LANCET 384.9957 (2014): 1869–1877. Print.
APA
Vogel, Joshua P, Souza, J. P., Gülmezoglu, A. M., Mori, R., Lumbiganon, P., Qureshi, Z., Carroli, G., et al. (2014). Use of antenatal corticosteroids and tocolytic drugs in preterm births in 29 countries: an analysis of the WHO Multicountry Survey on Maternal and Newborn Health. LANCET, 384(9957), 1869–1877.
Chicago author-date
Vogel, Joshua P, João Paulo Souza, A Metin Gülmezoglu, Rintaro Mori, Pisake Lumbiganon, Zahida Qureshi, Guillermo Carroli, et al. 2014. “Use of Antenatal Corticosteroids and Tocolytic Drugs in Preterm Births in 29 Countries: An Analysis of the WHO Multicountry Survey on Maternal and Newborn Health.” Lancet 384 (9957): 1869–1877.
Chicago author-date (all authors)
Vogel, Joshua P, João Paulo Souza, A Metin Gülmezoglu, Rintaro Mori, Pisake Lumbiganon, Zahida Qureshi, Guillermo Carroli, Malinee Laopaiboon, Bukola Fawole, Togoobaatar Ganchimeg, Jun Zhang, Maria Regina Torloni, Meghan Bohren, and Marleen Temmerman. 2014. “Use of Antenatal Corticosteroids and Tocolytic Drugs in Preterm Births in 29 Countries: An Analysis of the WHO Multicountry Survey on Maternal and Newborn Health.” Lancet 384 (9957): 1869–1877.
Vancouver
1.
Vogel JP, Souza JP, Gülmezoglu AM, Mori R, Lumbiganon P, Qureshi Z, et al. Use of antenatal corticosteroids and tocolytic drugs in preterm births in 29 countries: an analysis of the WHO Multicountry Survey on Maternal and Newborn Health. LANCET. 2014;384(9957):1869–77.
IEEE
[1]
J. P. Vogel et al., “Use of antenatal corticosteroids and tocolytic drugs in preterm births in 29 countries: an analysis of the WHO Multicountry Survey on Maternal and Newborn Health,” LANCET, vol. 384, no. 9957, pp. 1869–1877, 2014.
@article{5794770,
  abstract     = {{Background: Despite the global burden of morbidity and mortality associated with preterm birth, little evidence is available for use of antenatal corticosteroids and tocolytic drugs in preterm births in low-income and middle-income countries. We analysed data from the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS) to assess coverage for these interventions in preterm deliveries. 
Methods: WHOMCS is a facility-based, cross-sectional survey database of birth outcomes in 359 facilities in 29 countries, with data collected prospectively from May 1, 2010, to Dec 31, 2011. For this analysis, we included deliveries after 22 weeks' gestation and we excluded births that occurred outside a facility or quicker than 3 h after arrival. We calculated use of antenatal corticosteroids in women who gave birth between 26 and 34 weeks' gestation, when antenatal corticosteroids are known to be most beneficial. We also calculated use in women at 22-25 weeks' and 34-36 weeks' gestation. We assessed tocolytic drug use, with and without antenatal corticosteroids, in spontaneous, uncomplicated preterm deliveries at 26-34 weeks' gestation. 
Findings: Of 303 842 recorded deliveries after 22 weeks' gestation, 17 705 (6%) were preterm. 3900 (52%) of 7547 women who gave birth at 26-34 weeks' gestation, 94 (19%) of 497 women who gave birth at 22-25 weeks' gestation, and 2276 (24%) of 9661 women who gave birth at 35-36 weeks' gestation received antenatal corticosteroids. Rates of antenatal corticosteroid use varied between countries (median 54%, range 16-91%; IQR 30-68%). Of 4677 women who were potentially eligible for tocolysis drugs, 1276 (27%) were treated with bed rest or hydration and 2248 (48%) received no treatment. beta-agonists alone (n=346, 7%) were the most frequently used tocolytic drug. Only 848 (18%) of potentially eligible women received both a tocolytic drug and antenatal corticosteroids. 
Interpretation: Use of interventions was generally poor, despite evidence for their benefit for newborn babies. A substantial proportion of antenatal corticosteroid use occurred at gestational ages at which benefit is controversial, and use of less effective or potentially harmful tocolytic drugs was common. Implementation research and contextualised health policies are needed to improve drug availability and increase compliance with best obstetric practice.}},
  author       = {{Vogel, Joshua P and Souza, João Paulo and Gülmezoglu, A Metin and Mori, Rintaro and Lumbiganon, Pisake and Qureshi, Zahida and Carroli, Guillermo and Laopaiboon, Malinee and Fawole, Bukola and Ganchimeg, Togoobaatar and Zhang, Jun and Torloni, Maria Regina and Bohren, Meghan and Temmerman, Marleen}},
  issn         = {{0140-6736}},
  journal      = {{LANCET}},
  keywords     = {{TRIAL,RESPIRATORY-DISTRESS,INFANTS}},
  language     = {{eng}},
  number       = {{9957}},
  pages        = {{1869--1877}},
  title        = {{Use of antenatal corticosteroids and tocolytic drugs in preterm births in 29 countries: an analysis of the WHO Multicountry Survey on Maternal and Newborn Health}},
  url          = {{http://dx.doi.org/10.1016/S0140-6736(14)60580-8}},
  volume       = {{384}},
  year         = {{2014}},
}

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