Abstract：
BACKGROUND: Stillbirths are a major global health concern. Half of stillbirths occur during intrapartum period, mostly in low- and middle-income countries of sub-Saharan Africa and South Asia. Achieving a stillbirth rate of less than 12 per 1000 births by 2030 is the global target of Every Newborn Action Plan and Sustainable Development Goals. Evidence suggests that improving intrapartum quality of care can help reduce stillbirths and other adverse pregnancy outcomes. This study will explore whether quality improvement (QI) packages at intrapartum care points can reduce stillbirths and other outcomes such as maternal and neonatal mortality.
METHODS: We will conduct a systematic literature review and meta-analysis. Comprehensive search strategy will be developed for databases PubMed, Web of Science, ScienceDirect, ProQuest, Cochrane and China National Knowledge Infrastructure. We will include randomized controlled trials, controlled non-randomized trials, controlled clinical trials, interrupted time series, cohort studies, case-control and nested case-control studies which assess the impact of QI interventions at intrapartum points of care on stillbirths and other adverse pregnancy outcomes. We will search grey literature such as unpublished research studies, dissertations and unfinished trials. English and non-English language articles will be included to avoid language bias. We will also evaluate reporting quality and risk of bias. Sensitivity tests will be carried out for heterogeneity. Pooled estimates of effect sizes will be computed with random-effects models. Supplementation of the quantitative synthesis with a qualitative narrative synthesis would be added, if deemed necessary. We will explore publication bias using funnel plot and Egger\'s regression test will be used for evaluation, if needed.
CONCLUSIONS: We will report pooled effectiveness of different intrapartum QI interventions across multiple settings in averting stillbirths and other adverse outcomes such as maternal mortality and neonatal mortality.
METHODS: We will conduct a systematic literature review and meta-analysis. Comprehensive search strategy will be developed for databases PubMed, Web of Science, ScienceDirect, ProQuest, Cochrane and China National Knowledge Infrastructure. We will include randomized controlled trials, controlled non-randomized trials, controlled clinical trials, interrupted time series, cohort studies, case-control and nested case-control studies which assess the impact of QI interventions at intrapartum points of care on stillbirths and other adverse pregnancy outcomes. We will search grey literature such as unpublished research studies, dissertations and unfinished trials. English and non-English language articles will be included to avoid language bias. We will also evaluate reporting quality and risk of bias. Sensitivity tests will be carried out for heterogeneity. Pooled estimates of effect sizes will be computed with random-effects models. Supplementation of the quantitative synthesis with a qualitative narrative synthesis would be added, if deemed necessary. We will explore publication bias using funnel plot and Egger\'s regression test will be used for evaluation, if needed.
CONCLUSIONS: We will report pooled effectiveness of different intrapartum QI interventions across multiple settings in averting stillbirths and other adverse outcomes such as maternal mortality and neonatal mortality.
摘要：
背景：死胎是一个主要的全球健康问题。一半的死胎发生在产时期间，主要在撒哈拉以南非洲和南亚的低收入和中等收入国家。到2030年实现每千名新生儿中不到12例的死胎率是每个新生儿行动计划和可持续发展目标的全球目标。有证据表明，提高产时护理质量可以帮助减少死胎和其他不良妊娠结局。这项研究将探讨产时护理点的质量改善（QI）包是否可以减少死胎和其他结果，例如孕产妇和新生儿死亡率。
方法：我们将进行系统的文献综述和荟萃分析。将为PubMed数据库制定全面的搜索策略，WebofScience,ScienceDirect,ProQuest,科克伦与中国国家知识基础设施。我们将包括随机对照试验，非随机对照试验,对照临床试验,中断的时间序列，队列研究，病例对照和巢式病例对照研究，评估产时护理点QI干预对死胎和其他不良妊娠结局的影响。我们将搜索灰色文献，如未发表的研究报告，论文和未完成的试验。将包括英语和非英语语言文章，以避免语言偏见。我们还将评估报告质量和偏差风险。将对异质性进行敏感性测试。将使用随机效应模型计算效应大小的集合估计。将用定性叙事合成补充定量合成，如果认为有必要。我们将使用漏斗图和Egger的回归检验来探索出版偏差，如果需要。
结论：我们将报告跨多个环境的不同产时QI干预措施在避免死产和其他不良结局如孕产妇死亡率和新生儿死亡率方面的综合有效性。
方法：我们将进行系统的文献综述和荟萃分析。将为PubMed数据库制定全面的搜索策略，WebofScience,ScienceDirect,ProQuest,科克伦与中国国家知识基础设施。我们将包括随机对照试验，非随机对照试验,对照临床试验,中断的时间序列，队列研究，病例对照和巢式病例对照研究，评估产时护理点QI干预对死胎和其他不良妊娠结局的影响。我们将搜索灰色文献，如未发表的研究报告，论文和未完成的试验。将包括英语和非英语语言文章，以避免语言偏见。我们还将评估报告质量和偏差风险。将对异质性进行敏感性测试。将使用随机效应模型计算效应大小的集合估计。将用定性叙事合成补充定量合成，如果认为有必要。我们将使用漏斗图和Egger的回归检验来探索出版偏差，如果需要。
结论：我们将报告跨多个环境的不同产时QI干预措施在避免死产和其他不良结局如孕产妇死亡率和新生儿死亡率方面的综合有效性。
