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The article discusses the effectiveness of calcium supplementation in preventing pre-eclampsia during pregnancy. While some studies show modest reductions in pre-eclampsia with calcium supplementation, a broader consideration of evidence suggests benefits in reducing maternal death or serious morbidity. The authors suggest that low-dose calcium supplementation before and during early pregnancy may be more effective in preventing pre-eclampsia. The article also highlights the potential benefits of staple food fortification with calcium for improving pregnancy outcomes in populations with low calcium intake. [Extracted from the article]

Background: In most regions worldwide, caesarean section (CS) rates are increasing. In these settings, new strategies are needed to reduce CS rates.Objectives: To identify, critically appraise and synthesise studies using the Robson classification as a system to categorise and analyse data in clinical audit cycles to reduce CS rates.Search Strategy: Medline, Embase, CINAHL and LILACS were searched from 2001 to 2016.Selection Criteria: Studies reporting use of the Robson classification to categorise and analyse data in clinical audit cycles to reduce CS rates.Data Collection: Data on study design, interventions used, CS rates, and perinatal outcomes were extracted.Results: Of 385 citations, 30 were assessed for full text review and six studies, conducted in Brazil, Chile, Italy and Sweden, were included. All studies measured initial CS rates, provided feedback and monitored performance using the Robson classification. In two studies, the audit cycle consisted exclusively of feedback using the Robson classification; the other four used audit and feedback as part of a multifaceted intervention. Baseline CS rates ranged from 20 to 36.8%; after the intervention, CS rates ranged from 3.1 to 21.2%. No studies were randomised or controlled and all had a high risk of bias.Conclusion: We identified six studies using the Robson classification within clinical audit cycles to reduce CS rates. All six report reductions in CS rates; however, results should be interpreted with caution because of limited methodological quality. Future trials are needed to evaluate the role of the Robson classification within audit cycles aimed at reducing CS rates.Tweetable Abstract: Use of the Robson classification in clinical audit cycles to reduce caesarean rates. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the extent to which stillbirths affect international comparisons of preterm birth rates in low- and middle-income countries.Design: Secondary analysis of a multi-country cross-sectional study.Setting: 29 countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health.Population: 258 215 singleton deliveries in 286 hospitals.Methods: We describe how inclusion or exclusion of stillbirth affect rates of preterm births in 29 countries.Main Outcome Measures: Preterm delivery.Results: In all countries, preterm birth rates were substantially lower when based on live births only, than when based on total births. However, the increase in preterm birth rates with inclusion of stillbirths was substantially higher in low Human Development Index (HDI) countries [median 18.2%, interquartile range (17.2-34.6%)] compared with medium (4.3%, 3.0-6.7%), and high-HDI countries (4.8%, 4.4-5.5%).Conclusion: Inclusion of stillbirths leads to higher estimates of preterm birth rate in all countries, with a disproportionately large effect in low-HDI countries. Preterm birth rates based on live births alone do not accurately reflect international disparities in perinatal health; thus improved registration and reporting of stillbirths are necessary.Tweetable Abstract: Inclusion of stillbirths increases preterm birth rates estimates, especially in low-HDI countries. [ABSTRACT FROM AUTHOR]

Background: Oxytocin is the drug of choice for preventing and treating postpartum haemorrhage, an important cause of maternal death. Oxytocin is widely available in low and middle-income countries (LMIC) but there are concerns about its quality.Objective: To identify, critically appraise and synthesise the findings of studies on the quality of oxytocin available in LMIC.Search Strategy: We searched seven electronic databases, without language restriction.Selection Criteria: Studies reporting results of tests to assess quality of oxytocin samples from LMIC.Data Collection and Analysis: Study selection, data extraction and quality assessment were performed in duplicate. Results are presented descriptively.Main Results: The search identified 2611 unique citations; eight studies, assessing 559 samples from 15 different countries were included. Most samples were collected from facility level settings (n = 509) and from the private sector (n = 321). The median prevalence of oxytocin samples that failed quality tests was 45.6% (range 0-80%), mostly due to insufficient amounts of active pharmacological ingredient. Over one-third of the samples (n = 204) had low (<90%) oxytocin content indicating substandard medicine; two samples had no active ingredient, suggesting possible counterfeit drugs. The proportion of low fails was higher in samples collected in Africa than in Asia or Latin America (57.5% versus 22.3% versus 0%, respectively, P < 0.0001), in private than in public sectors (34.0% versus 25.3%, P = 0.032) and in facilities than in central distributors (37.9% versus 22.0%, P = 0.030).Conclusion: There is a high prevalence of poor-quality oxytocin samples in LMIC countries, mainly due to inadequate amounts of active ingredient.Tweetable Abstract: Systematic review points to problems with quality of oxytocin samples from low- and middle-income countries. [ABSTRACT FROM AUTHOR]