title: Impact of interventions to prevent and manage preeclampsia and eclampsia on stillbirths.
abstract: BACKGROUND
  Pre-eclampsia and Eclampsia are relatively common complications of pregnancy, leading to considerable maternal and fetal mortality and morbidity. We sought to review the effect of aspirin, calcium supplementation, antihypertensive agents and magnesium sulphate on risk stillbirths.
  
  
  METHODS
  A systematic literature search was conducted to identify studies evaluating the above interventions. We used a standardized abstraction and grading format and performed meta-analyses where data were available from more than one studies. The estimated effect on stillbirths was determined by applying the standard Child Health Epidemiology Reference Group (CHERG) rules for multiple outcomes. For interventions with insufficient evidence for overall effect, a Delphi process was undertaken to estimate effectiveness.
  
  
  RESULTS
  We identified 82 relevant studies. For aspirin, maganesium sulphate and use of antihypertensive we found an insignificant decrease in stillbirth and perinatal mortality. For calcium supplementation, there was a borderline significant reduction in stillbirths (RR 0.81, 95 % CI 0.63-1.03). We undertook a Delphi consultation among experts to assess the potential impact of a package of interventions for the management of pre-eclampsia and eclampsia (antihypertensive, magnesium sulphate and C-section if needed). The Delphi process suggested 20% reduction each in both antepartum and intrapartum stillbirths with the use of this package.
  
  
  CONCLUSIONS
  Despite promising benefits of calcium supplementation and aspirin use cases on maternal morbidity and eclampsia in high risk cases, further work is needed to ascertain their benefits in relation to stillbirths. The Delphi process undertaken for assessing potential impact of a package of interventions indicated that this could be associated with 20% reduction in stillbirths, for input into LiST.
authors.affiliation: Division of Women & Child Health, The Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan.
authors.forename: Mehnaz
authors.initials: M
authors.lastname: Jabeen
authors.forename: Mohammad Yawar
authors.initials: MY
authors.lastname: Yakoob
authors.forename: Aamer
authors.initials: A
authors.lastname: Imdad
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002118:Calcium / Q000008:administration & dosage; D019587:Dietary Supplements; D004461:Eclampsia / Q000188:drug therapy* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008278:Magnesium Sulfate / Q000627:therapeutic use; D011225:Pre-Eclampsia / Q000188:drug therapy* / Q000517:prevention & control*; D011247:Pregnancy; D050497:Stillbirth / Q000453:epidemiology*
chemical_list: D000959:Antihypertensive Agents; D008278:Magnesium Sulfate; D001241:Aspirin; D002118:Calcium