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2. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Author

Shakur, Haleema, Roberts, Ian, Fawole, Bukola, Chaudhri, Rizwana, El-Sheikh, Mohamed, Akintan, Adesina, Qureshi, Zahida, Kidanto, Hussein, Vwalika, Bellington, Abdulkadir, Abdulfetah, Etuk, Saturday, Noor, Shehla, Asonganyi, Etienne, Alfirevic, Zarko, Beaumont, Danielle, Ronsmans, Carine, Arulkumaran, Sabaratnam, Grant, Adrian, Afsana, Kaosar, Gülmezoglu, Metin, Hunt, Beverley, Olayemi, Oladapo, Chalmers, Iain, Lumbiganon, Pisake, Piaggio, Gilda, Brady, Tony, Elbourne, Diana, Balogun, Eni, Pepple, Tracey, Prowse, Danielle, Quashi, Nigel, Barneston, Lin, Barrow, Collette, Cook, Lisa, Frimley, Lauren, Gilbert, Daniel, Gilliam, Catherine, Jackson, Rob, Kawahara, Taemi, Miah, Hakim, Kostrov, Sergey, Ramos, Maria, Edwards, Phil, Godec, Tom, Huque, Sumaya, Okunade, Olujide, Adetayo, Olusade, Kayani, Aasia, Javaid, Kiran, Biryabarema, Chrstine, Tchounzou, Robert, Regmi, Mohan, Dallaku, Kastriot, Sahani, Mateus, Akhter, Sayeba, Meda, Nicolas, Dah, Anthony Kwame, Odekunle, Olufemi, Monehin, Oluwabusola, Ojo, Austin, Akinbinu, Grace, Offiah, Ifeoma, Akpan, Ubong, Udofia, Uduak, Okon, Useneno, Omoronyia, Ezukwa, James, Okpe, Bello, Nike, Adeyemi, Blessed, Aimakhu, Chris, Akinsanya, Olufemi, Adeleye, Bamidele, Adeyemi, Oluwaseun, Oluwatosin, Kayode, Aboyeji, Abiodun, Adeniran, Abiodun, Adewale, Adebayo, Olaomo, Noah, Omo-Aghoja, Lawrence, Okpako, Emmanuel, Oyeye, Lucky, Alu, Francis, Ogudu, John, Ladan, Ezekiel, Habib, Ibrahim, Okusanya, Babasola, Onafowokan, Olatunde, Isah, David, Aye, Abalaka, Okogbo, Felix, Aigere, Egbaname, Ogbiti, Mark, Onile, Temitope, Salau, Olaide, Amode, Yinka, Shoretire, Kamil, Owodunni, Adebola, Ologunde, Kehinde, Ayinde, Akintunde, Alao, Moses, Awonuga, Olalekan, Awolaja, Babatunde, Adegbola, Omololu, Habeebu-Adeyemi, Fatimah, Okunowo, Adeyemi, Idris, Hadiza, Okike, Ola, Madueke, Nneka, Mutihir, Josiah, Joseph, Nankat, Adebudo, Babatunde, Fasanu, Adeniyi, Akintunde, Olugbenga, Abidoye, Olufemi, Opreh, Owigho, Udonwa, Sophia, Dibia, Gladys, Bazuaye, Simeon, Ifemeje, Arafat, Umoiyoho, Aniefiok, Inyang-Etoh, Emmanuel, Yusuf, Sununu, Olayinka, Kayode, Adeyemi, Babalola, Ajenifuja, Olusegun, Ibrahim, Umar, Adamu, Yusuf Baffah, Akinola, Oluwarotimi, Adekola-Oni, Grace, Kua, Paul, Iheagwam, Roseline, Idrisa, Audu, Geidam, Ado, Jogo, Andrea, Agulebe, Joseph, Ikechebelu, Joseph, Udegbunam, Onyebuchi, Awoleke, Jacob, Adelekan, Oluseyi, Sulayman, Hajaratu, Ameh, Nkeiruka, Onaolapo, Nurudeen, Adelodun, Affiss, Golit, William, Audu, Dachollom, Adeniji, Adetunji, Oyelade, Folasade, Dattijo, Lamaran, Henry, Palmer, Loto, Olabisi, Umeora, Odidika, Onwe, Abraham, Nzeribe, Emily, Okorochukwu, Bartthy, Adeniyi, Augustine, Gbejegbe, Emmanuel, Ikpen, Akpojaro, Nwosu, Ikemefuna, Sambo, Abdulrasaq, Ladipo, Olubunmi, Abubakar, Sola, Okike, Ola Nene, Nduka, Enyinnaya Chikwendu, Ezenkwele, Eziamaka Pauline, Onwusulu, Daniel, Irinyenikan, Theresa Azonima, Singh, Swati, Bariweni, Amaitari, Galadanci, Hadiza, Achara, Peter, Osayande, Osagie, Gana, Mohammed, Jabeen, Kiran, Mobeen, Ayesha, Mufti, Sadaf, Zafar, Maliha, Ahmad, Basharat, Munawar, Maimoona, Gul, Jeharat, Usman, Naseema, Shaheen, Fehmida, Tariq, Mariam, Sadiq, Nadia, Batool, Rabia, Ali, Habiba Sharaf, Jaffer, Manahil, Baloch, Asma, Mukhtiar, Noonari, Ashraf, Tasneem, Asmat, Raheela, Khudaidad, Salma, Taj, Ghazala, Qazi, Roshan, Dars, Saira, Sardar, Faryal, Ashfaq, Sanobar, Majeed, Saeeda, Jabeen, Sadaqat, Karim, Rukhsana, Burki, Farzana, Bukhari, Syeda Rabia, Gul, Fouzia, Jabeen, Musarrat, Sherin, Akhtar, Ain, Qurratul, Rao, Shahid, Shaheen, Uzma, Manzoor, Samina, Masood, Shabween, Rizvi, Shabana, Ali, Anita, Sajid, Abida, Iftikhar, Aisha, Batool, Shazia, Dar, Lubna, Sohail, Shahenzad, Rasul, Shazia, Humayun, Shamsa, Sultana, Rashida, Manzoor, Sofia, Mazhar, Syeda, Batool, Afshan, Nazir, Asia, Tasnim, Nasira, Masood, Hajira, Khero, Razia, Surhio, Neelam, Aleem, Samana, Israr, Naila, Javed, Saba, Bashir, Lubna, Iqbal, Samina, Aleem, Faiza, Sohail, Rubina, Iqbal, Saima, Dojki, Samina, Bano, Alia, Saba, Naseem, Hafeez, Maimoona, Akram, Nishat, Shaheen, Riffat, Hashmi, Haleema, Arshad, Sharmeen, Hussain, Rubina, Khan, Sadia, Shaheen, Nighat, Khalil, Safia, Sachdev, Pushpa, Arain, Gulfareen, Zarreen, Amtullah, Saeed, Sara, Hanif, Shamayela, Tariq, Nabia, Jamil, Mahwish, Chaudhry, Shama, Rajani, Hina, Wasim, Tayyiba, Aslam, Summera, Mustafa, Nilofar, Quddusi, Huma, Karim, Sajila, Sultana, Shazia, Harim, Misbah, Chohan, Mohd, Salman, Nabila, Waqar, Fareesa, Sadia, Shamsunnisa, Kahloon, Lubna, Manzoor, Shehla, Amin, Samar, Akram, Umbreen, Ikram, Ambreen, Kausar, Samina, Batool, Tahira, Naila, Brigadier, Kyani, Tahir, Biryabarema, Christine, Bulime, Ruth, Akello, Regina, Lwasa, Bernadette Nakawooya, Ayikoru, Joselyn, Namulwasira, Christine, Komagum, Patrick, Rebecca, Isabirye, Annet, Nayiga, Nuulu, Nakirigya, Nionzima, Elizabeth, Bwotya, Rose, Nankya, Margret, Babirye, Sarah, (RIP), Ngonzi, Joseph, Sanchez, Cesar, Innocent, Nkonwa, Anitah, Kusasira, Jackson, Ayiko, Ndagire, Elizabeth, Nanyongo, Christine, Drametu, Dominic, Meregurwa, Grace, Banya, Francis, Atim, Rita, Byaruhanga, Emmanuel, Felix, Lema, Iman, Hussein, Oyiengo, Vincent, Waigi, Peninah, Wangui, Rose, Nassir, Faiza, Soita, Musimbi, Msengeti, Rophina, Zubier, Zeinab, Mabeya, Hillary, Wanjala, Antony, Mwangi, Henry, Liyayi, Brian, Muthoka, Evelyn, Osoti, Alfred, Otara, Amos, Ongwae, Veronicah, Wanjohi, Victor, Musila, Bonface, Wekesa, Kubasu, Bosire, Alex Nyakundi, Ntem, Alice, Njoache, Angeline, Ashu, Alice, Simo, André, Keka, Dorothy, Bruno, Kenfack, Ndouoya, Amadou, Saadio, Martin, Tchana, Mesack, Gwan, Odel, Assomo, Pauline, Mutsu, Venantius, Eric, Nji, Foumane, Pascal, Nsem, Philemon, Fouedjio, Jeanne, Fouelifack, Ymele, Tebeu, Pierre Marie, Nko'ayissi, Georges, Mbong, Eta Ngole, Nabag, Wisal, Desougi, Riham, Mustafa, Hadia, Eltaib, Huida, Umbeli, Taha, Elfadl, Khalid, Ibrahim, Murwan, Mohammed, Abdalla, Ali, Awadia, Abdelrahiem, Somia, Musa, Mohammed, Awadalla, Khidir, Ahmed, Samirra, Bushra, Mahdi, Babiker, Omer, Abdullahi, Hala, Ahmed, Mohamed, Safa, Elhassan, Almardi, Huida, Rayis, Duria, Abdelgabar, Saeed Abdelrahman, Houghton, Gillian, Sharpe, Andrew, Thornton, Jim, Grace, Nick, Smith, Carys, Hinshaw, Kim, Edmundson, Dawn, Ayuk, Paul, Bates, Alison, Bugg, George, Wilkins, Joanne, Tower, Clare, Allibone, Alysha, Oteng-Ntim, Eugene, Kazumari, Ahmad, Danford, Anna, Ngarina, Matilda, Abeid, Muzdalifat, Mayumba, Khadija, Zacharia, Magreth, Mtove, George, Madame, Leonard, Massinde, Anthony, Mwambe, Berno, Onesmo, Rwakyendela, Ganyaka, Sebastian Kitengile, Gupta, Shyam, Bhatt, Rabindra, Agrawal, Ajay, Pradhan, Pramila, Dhakal, Nikita, Yadav, Punita, Karki, Gyanendra, Shrestha, Bhola Ram, Lubeya, Mwansa, Mumba, Jane, Silwimba, Willies, Hansingo, Isaiah, Bopili, Noojiri, Makukula, Ziche, Kawimbe, Alexander, Lubeya, Mwansa Ketty, Mtambo, Willard, Ng'ambi, Mathew, Cenameri, Saimir, Tasha, Ilir, Kruja, Aferdita, Brahimaj, Besnik, Tola, Armida, Kaza, Leon, Tshombe, Desire, Buligho, Elizabeth, Paluku-Hamuli, Roger, Kacha, Charles, Faida, Kato, Musau, Badibanga, Kalyana, Herman, Simisi, Phanny, Mulyumba, Serge, Jason, Nzanzu Kikuhe, Lubamba, Jean Robert, Missumba, Willis, Islam, Ferdousi, Begum, Nazneen, Chowdhury, Ferdousi, Begum, Rokeya, Basher, Farjana, Nargis, Nazlima, Kholdun, Abu, Jesmin, Shahela, Paul, Shrodha, Segni, Hailemariam, Ayana, Getachew, Haleke, William, Hussien, Hassen, Geremew, Fikre, Bambara, Moussa, Somé, Adolphe, Ly, Amadou, Pabakba, Roamba, Fletcher, Horace, Samuels, Leslie, Opare-Addo, Henry, Larsen-Reindorf, Roderick, Nyarko-Jectey, Kwadwo, Mola, Glen, Wai, Malts, El Rahman, Magdy, Basta, Wafaa, Khamis, Hussein, Escobar, Maria Fernanda, Vallecilla, Liliana, and Faye, Gabriel Essetchi

Published
2017
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3. “By slapping their laps, the patient will know that you truly care for her”: A qualitative study on social norms and acceptability of the mistreatment of women during childbirth in Abuja, Nigeria

Author

Bohren, Meghan A., Vogel, Joshua P., Tunçalp, Özge, Fawole, Bukola, Titiloye, Musibau A., Olutayo, Akinpelu Olanrewaju, Oyeniran, Agnes A., Ogunlade, Modupe, Metiboba, Loveth, Osunsan, Olubunmi R., Idris, Hadiza A., Alu, Francis E., Oladapo, Olufemi T., Gülmezoglu, A. Metin, and Hindin, Michelle J.

Published
2016
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4. Negotiating quality standards for effective delivery of labor and childbirth care in Nigeria and Uganda

Author

Oladapo, Olufemi T., Bohren, Meghan A., Fawole, Bukola, Mugerwa, Kidza, Ojelade, Olubunmi A., Titiloye, Musibau A., Alu, Francis E., Mambya, Musana O., Oyeneyin, Lawal, Bataale, Salim, Akintan, Adesina, Alabi, Olubunmi, Adebayo, Amos, Okike, Ola, Idris, Hadiza A., Wilfred, Sanni, Bello, Halima, Kyaddondo, David, Olutayo, Akinpelu O., Byamugisha, Josaphat, Souza, Joao Paulo, and Gülmezoglu, A. Metin

Published
2017
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5. Progression of the first stage of spontaneous labour: A prospective cohort study in two sub-Saharan African countries

Author

Oladapo, Olufemi T., Souza, Joao Paulo, Fawole, Bukola, Mugerwa, Kidza, Perdoná, Gleici, Alves, Domingos, Souza, Hayala, Reis, Rodrigo, Oliveira-Ciabati, Livia, Maiorano, Alexandre, Akintan, Adesina, Alu, Francis E., Oyeneyin, Lawal, Adebayo, Amos, Byamugisha, Josaphat, Nakalembe, Miriam, Idris, Hadiza A., Okike, Ola, Althabe, Fernando, Hundley, Vanora, Donnay, France, Pattinson, Robert, Sanghvi, Harshadkumar C., Jardine, Jen E., Tunçalp, Özge, Vogel, Joshua P., Stanton, Mary Ellen, Bohren, Meghan, Zhang, Jun, Lavender, Tina, Liljestrand, Jerker, ten Hoope-Bender, Petra, Mathai, Matthews, Bahl, Rajiv, and Gülmezoglu, A. Metin

Subjects
Markov processes -- Analysis -- Research, Pregnant women -- Health aspects, Cesarean section -- Analysis -- Research -- Patient outcomes -- Development and progression, Biological sciences, World Health Organization
Abstract

Background Escalation in the global rates of labour interventions, particularly cesarean section and oxytocin augmentation, has renewed interest in a better understanding of natural labour progression. Methodological advancements in statistical and computational techniques addressing the limitations of pioneer studies have led to novel findings and triggered a re-evaluation of current labour practices. As part of the World Health Organization's Better Outcomes in Labour Difficulty (BOLD) project, which aimed to develop a new labour monitoring-to-action tool, we examined the patterns of labour progression as depicted by cervical dilatation over time in a cohort of women in Nigeria and Uganda who gave birth vaginally following a spontaneous labour onset. Methods and findings This was a prospective, multicentre, cohort study of 5,606 women with singleton, vertex, term gestation who presented at [less than or equal to] 6 cm of cervical dilatation following a spontaneous labour onset that resulted in a vaginal birth with no adverse birth outcomes in 13 hospitals across Nigeria and Uganda. We independently applied survival analysis and multistate Markov models to estimate the duration of labour centimetre by centimetre until 10 cm and the cumulative duration of labour from the cervical dilatation at admission through 10 cm. Multistate Markov and nonlinear mixed models were separately used to construct average labour curves. All analyses were conducted according to three parity groups: parity = 0 (n = 2,166), parity = 1 (n = 1,488), and parity = 2+ (n = 1,952). We performed sensitivity analyses to assess the impact of oxytocin augmentation on labour progression by re-examining the progression patterns after excluding women with augmented labours. Labour was augmented with oxytocin in 40% of nulliparous and 28% of multiparous women. The median time to advance by 1 cm exceeded 1 hour until 5 cm was reached in both nulliparous and multiparous women. Based on a 95th percentile threshold, nulliparous women may take up to 7 hours to progress from 4 to 5 cm and over 3 hours to progress from 5 to 6 cm. Median cumulative duration of labour indicates that nulliparous women admitted at 4 cm, 5 cm, and 6 cm reached 10 cm within an expected time frame if the dilatation rate was [greater than or equal to] 1 cm/hour, but their corresponding 95th percentiles show that labour could last up to 14, 11, and 9 hours, respectively. Substantial differences exist between actual plots of labour progression of individual women and the 'average labour curves' derived from study population-level data. Exclusion of women with augmented labours from the study population resulted in slightly faster labour progression patterns. Conclusions Cervical dilatation during labour in the slowest-yet-normal women can progress more slowly than the widely accepted benchmark of 1 cm/hour, irrespective of parity. Interventions to expedite labour to conform to a cervical dilatation threshold of 1 cm/hour may be inappropriate, especially when applied before 5 cm in nulliparous and multiparous women. Averaged labour curves may not truly reflect the variability associated with labour progression, and their use for decision-making in labour management should be de-emphasized., Author(s): Olufemi T. Oladapo 1,*, Joao Paulo Souza 1, Bukola Fawole 2, Kidza Mugerwa 3, Gleici Perdoná 4, Domingos Alves 4, Hayala Souza 4, Rodrigo Reis 4, Livia Oliveira-Ciabati 4, [...]

Published
2018
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6. Maternal BMI at the time of birth and selected risk factors associated with severe neonatal outcomes: a secondary analysis of the WHO Better Outcomes in Labour Difficulty (BOLD) project

Author

Pileggi, Vicky N., primary, Oladapo, Olufemi T., additional, Cavenague de Souza, Hayala Cristina, additional, Castro, Cynthia P., additional, Abraham, Alabi O., additional, Akintan, Adesina L., additional, Idris, Hadiza A., additional, Oyeneyin, Lawal O., additional, Souza, João P., additional, and Camelo, José S., additional

Published
2020
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7. Mistreatment of women during childbirth in Abuja, Nigeria: a qualitative study on perceptions and experiences of women and healthcare providers

Author

Bohren, Meghan A., primary, Vogel, Joshua P., additional, Tunçalp, Özge, additional, Fawole, Bukola, additional, Titiloye, Musibau A., additional, Olutayo, Akinpelu Olanrewaju, additional, Ogunlade, Modupe, additional, Oyeniran, Agnes A., additional, Osunsan, Olubunmi R., additional, Metiboba, Loveth, additional, Idris, Hadiza A., additional, Alu, Francis E., additional, Oladapo, Olufemi T., additional, Gülmezoglu, A. Metin, additional, and Hindin, Michelle J., additional

Published
2017
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9. How women are treated during facility-based childbirth: development and validation of measurement tools in four countries -- phase 1 formative research study protocol.

Author

Vogel, Joshua P., Bohren, Meghan A., Tunçalp, Özge, Oladapo, Olufemi T., Adanu, Richard M., Baldé, Mamadou Diouldé, Thae Maung Maung, Fawole, Bukola, Adu-Bonsaffoh, Kwame, Dako-Gyeke, Phyllis, Maya, Ernest Tei, Camara, Mohamed Campell, Diallo, Alfa Boubacar, Diallo, Safiatou, Khin Thet Wai, Theingi Myint, Olutayo, Lanre, Titiloye, Musibau, Alu, Frank, and Idris, Hadiza

Subjects
ATTITUDE (Psychology), CHILDBIRTH, CULTURE, DISCRIMINATION (Sociology), FOCUS groups, INTERVIEWING, MATERNAL health services, RESEARCH methodology, MEDICAL quality control, MEDICAL personnel, PATIENT abuse, PATIENT safety, SENSORY perception, POPULATION geography, RESEARCH evaluation, RESEARCH ethics, RURAL hospitals, URBAN hospitals, VIOLENCE, QUALITATIVE research, JUDGMENT sampling, PATIENTS' attitudes, MEDICAL coding, PSYCHOLOGICAL vulnerability
Abstract

Background: Every woman has the right to dignified, respectful care during childbirth. Recent evidence has demonstrated that globally many women experience mistreatment during labour and childbirth in health facilities, which can pose a significant barrier to women attending facilities for delivery and can contribute to poor birth experiences and adverse outcomes for women and newborns. However there is no clear consensus on how mistreatment of women during childbirth in facilities is defined and measured. We propose using a two-phased, mixed-methods study design in four countries to address these research gaps. This protocol describes the Phase 1 qualitative research activities. Methods/Design: We will employ qualitative research methodologies among women, healthcare providers and administrators in the facility catchment areas of two health facilities in each country: Ghana, Guinea, Myanmar and Nigeria. In-depth interviews (IDIs) and focus group discussions (FGDs) will be conducted among women of reproductive age (15-49 years) to explore their perceptions and experiences of facility-based childbirth care, focused on how they were treated by healthcare workers and perceived factors affecting how they were treated. IDIs will also be conducted with healthcare providers of different cadres (e.g.: nurses, midwives, medical officers, specialist obstetricians) and facility administrators working in the selected facilities to explore healthcare providers' perceptions and experiences of facility-based childbirth care and how staff are treated, colleagues and supervisors. Audio recordings will be transcribed and translated to English. Textual data will be analysed using a thematic framework approach and will consist of two levels of analysis: (1) conduct of local analysis workshops with the research assistants in each country; and (2) line-by-line coding to develop a thematic framework and coding scheme. Discussion: This study serves several roles. It will provide an in-depth understanding of how women are treated during childbirth in four countries and perceived factors associated with this mistreatment. It will also provide data on where and how an intervention could be developed to reduce mistreatment and promote respectful care. The findings from this study will contribute to the development of tools to measure the prevalence of mistreatment of women during facility-based childbirth. [ABSTRACT FROM AUTHOR]

Published
2015
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10. Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries.

Author

Oladapo OT, Vogel JP, Piaggio G, Nguyen MH, Althabe F, Gülmezoglu AM, Bahl R, Rao SPN, De Costa A, Gupta S, Baqui AH, Khanam R, Shahidullah M, Chowdhury SB, Ahmed S, Begum N, D Roy A, Shahed MA, Jaben IA, Yasmin F, Rahman MM, Ara A, Khatoon S, Ara G, Akter S, Akhter N, Dey PR, Sabur MA, Azad MT, Choudhury SF, Matin MA, Goudar SS, Dhaded SM, Metgud MC, Pujar YV, Somannavar MS, Vernekar SS, Herekar VR, Bidri SR, Mathapati SS, Patil PG, Patil MM, Gudadinni MR, Bijapure HR, Mallapur AA, Katageri GM, Chikkamath SB, Yelamali BC, Pol RR, Misra SS, Das L, Nanda S, Nayak RB, Singh B, Qureshi Z, Were F, Osoti A, Gwako G, Laving A, Kinuthia J, Mohamed H, Aliyan N, Barassa A, Kibaru E, Mbuga M, Thuranira L, Githua NJ, Lusweti B, Ayede AI, Falade AG, Adesina OA, Agunloye AM, Iyiola OO, Sanni W, Ejinkeonye IK, Idris HA, Okoli CV, Irinyenikan TA, Olubosede OA, Bello O, Omololu OM, Olutekunbi OA, Akintan AL, Owa OO, Oluwafemi RO, Eniowo IP, Fabamwo AO, Disu EA, Agbara JO, Adejuyigbe EA, Kuti O, Anyabolu HC, Awowole IO, Fehintola AO, Kuti BP, Isah AD, Olateju EK, Abiodun O, Dedeke OF, Akinkunmi FB, Oyeneyin L, Adesiyun O, Raji HO, Ande ABA, Okonkwo I, Ariff S, Soofi SB, Sheikh L, Zulfiqar S, Omer S, Sikandar R, Sheikh S, Giordano D, Gamerro H, Carroli G, Carvalho J, Neilson J, Molyneux E, Yunis K, Mugerwa K, and Chellani HK

Subjects
Adult, Developing Countries, Female, Humans, Infant, Low Birth Weight, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases epidemiology, Injections, Intramuscular, Pregnancy, Premature Birth, Risk, Stillbirth epidemiology, Dexamethasone administration & dosage, Glucocorticoids administration & dosage, Infant, Premature, Diseases prevention & control, Perinatal Death prevention & control, Prenatal Care
Abstract

Background: The safety and efficacy of antenatal glucocorticoids in women in low-resource countries who are at risk for preterm birth are uncertain., Methods: We conducted a multicountry, randomized trial involving pregnant women between 26 weeks 0 days and 33 weeks 6 days of gestation who were at risk for preterm birth. The participants were assigned to intramuscular dexamethasone or identical placebo. The primary outcomes were neonatal death alone, stillbirth or neonatal death, and possible maternal bacterial infection; neonatal death alone and stillbirth or neonatal death were evaluated with superiority analyses, and possible maternal bacterial infection was evaluated with a noninferiority analysis with the use of a prespecified margin of 1.25 on the relative scale., Results: A total of 2852 women (and their 3070 fetuses) from 29 secondary- and tertiary-level hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan underwent randomization. The trial was stopped for benefit at the second interim analysis. Neonatal death occurred in 278 of 1417 infants (19.6%) in the dexamethasone group and in 331 of 1406 infants (23.5%) in the placebo group (relative risk, 0.84; 95% confidence interval [CI], 0.72 to 0.97; P = 0.03). Stillbirth or neonatal death occurred in 393 of 1532 fetuses and infants (25.7%) and in 444 of 1519 fetuses and infants (29.2%), respectively (relative risk, 0.88; 95% CI, 0.78 to 0.99; P = 0.04); the incidence of possible maternal bacterial infection was 4.8% and 6.3%, respectively (relative risk, 0.76; 95% CI, 0.56 to 1.03). There was no significant between-group difference in the incidence of adverse events., Conclusions: Among women in low-resource countries who were at risk for early preterm birth, the use of dexamethasone resulted in significantly lower risks of neonatal death alone and stillbirth or neonatal death than the use of placebo, without an increase in the incidence of possible maternal bacterial infection. (Funded by the Bill and Melinda Gates Foundation and the World Health Organization; Australian and New Zealand Clinical Trials Registry number, ACTRN12617000476336; Clinical Trials Registry-India number, CTRI/2017/04/008326.)., (Copyright © 2020 Massachusetts Medical Society.)

Published
2020
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