The evidence for emergency obstetric care.
OBJECTIVE
We searched for evidence for the effectiveness of emergency obstetric care (EmOC) interventions in reducing maternal mortality primarily in developing countries.


METHODS
We reviewed population-based studies with maternal mortality as the outcome variable and ranked them according to the system for ranking the quality of evidence and strength of recommendations developed by the US Preventive Services Task Force. A systematic search of published literature was conducted for this review, including searches of Medline, PubMed, Cochrane Database of Systematic Reviews, the Cochrane Pregnancy and Childbirth Database and the Cochrane Controlled Trials Register.


RESULTS
The strength of the evidence is high in several studies with a design that places them in the second and third tier in the quality of evidence ranking system. No studies were found that are experimental in design that would give them a top ranking, due to the measurement challenges associated with maternal mortality, although many of the specific individual clinical interventions that comprise EmOC have been evaluated through experimental design. There is strong evidence based on studies, using quasi-experimental, observational and ecological designs, to support the contention that EmOC must be a critical component of any program to reduce maternal mortality.
Paxton
A
A
Averting Maternal Death and Disability (AMDD) Program, Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USA. ap428@columbia.edu
Maine
D
D
Freedman
L
L
Fry
D
D
Lobis
S
S
D003906:Developing Countries; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008427:Maternal Health Services / Q000592:standards*; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control; D013188:Sri Lanka / Q000453:epidemiology