***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Previous estimates have highlighted a large global burden of stillbirths , with an absence of reliable data from regions where most stillbirths occur . The Every Newborn Action Plan ( ENAP ) targets national stillbirth rates ( SBRs ) of 12 or fewer stillbirths per 1000 births by 2030 . We estimate SBRs and numbers for 195 countries , including trends from 2000 to 2015 . METHODS We collated  SBR data meeting prespecified inclusion criteria from national routine or registration systems , nationally representative surveys , and other data sources identified through a systematic review , web-based search es , and consultation with stillbirth experts . We modelled SBR ( ≥28 weeks ' gestation ) for 195 countries with restricted maximum likelihood estimation with country-level r and om effects . Uncertainty ranges were obtained through a bootstrap approach . FINDINGS Data from 157 countries ( 2207 data points ) met the inclusion criteria , a 90 % increase from 2009 estimates . The estimated average global SBR in 2015 was 18·4 per 1000 births , down from 24·7 in 2000 ( 25·5 % reduction ) . In 2015 , an estimated 2·6 million ( uncertainty range 2·4 - 3·0 million ) babies were stillborn , giving a 19 % decline in numbers since 2000 with the slowest progress in sub-Saharan Africa . 98 % of all stillbirths occur in low-income and middle-income countries ; 77 % in south Asia and sub-Saharan Africa . INTERPRETATION Progress in reducing the large worldwide stillbirth burden remains slow and insufficient to meet national targets such as for ENAP . Stillbirths are increasingly being counted at a local level , but countries and the global community must further improve the quality and comparability of data , and ensure that this is more clearly linked to accountability processes including the Sustainable Development Goals . FUNDING Save the Children 's Saving Newborn Lives programme to The London School of Hygiene & Tropical Medicine Background Escalation in the global rates of labour interventions , particularly cesarean section and oxytocin augmentation , has renewed interest in a better underst and ing of natural labour progression . Method ological 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 practice s. As part of the World Health Organization 's Better Outcomes in Labour Difficulty ( BOLD ) project , which aim ed 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 Ug and a who gave birth vaginally following a spontaneous labour onset . Methods and findings This was a prospect i ve , multicentre , cohort study of 5,606 women with singleton , vertex , term gestation who presented at ≤ 6 cm of cervical dilatation following a spontaneous labour onset that result ed in a vaginal birth with no adverse birth outcomes in 13 hospitals across Nigeria and Ug and a. 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 ≥ 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 result ed 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 Objective In the context of rapid changes regarding practice s related to delivery in Africa , we assessed maternal and perinatal adverse outcomes associated with the mode of delivery in 41 referral hospitals of Mali and Senegal . Study Design Cross-sectional survey nested in a r and omised cluster trial ( 1/10/2007–1/10/2008 ) . The associations between intended mode of delivery and ( i ) in-hospital maternal mortality , ( ii ) maternal morbidity ( transfusion or hysterectomy ) , ( iii ) stillbirth or neonatal death before Day 1 and ( iv ) neonatal death between 24 hours after birth and hospital discharge were examined . We excluded women with immediate life threatening maternal or fetal complication to avoid indication bias . The analyses were performed using hierarchical logistic mixed models with r and om intercept and were adjusted for women 's , newborn 's and hospitals ' characteristics . Results Among the 78,166 included women , 2.2 % had a pre-labor cesarean section ( CS ) and 97.8 % had a trial of labor . Among women with a trial of labor , 87.5 % delivered vaginally and 12.5 % had intrapartum CS . Pre-labor CS was associated with a marked reduction in the risk of stillbirth or neonatal death before Day 1 as compared with trial of labor ( OR = 0.2 [ 0.16–0.36 ] ) , though we did not show that maternal mortality ( OR = 0.3 [ 0.07–1.32 ] ) and neonatal mortality after Day 1 ( OR = 1.3 ( 0.66–2.72 ] ) differed significantly between groups . Among women with trial of labor , intrapartum CS and operative vaginal delivery were associated with higher risks of maternal mortality and morbidity , and neonatal mortality after Day 1 , as compared with spontaneous vaginal delivery . Conclusions In referral hospitals of Mali and Senegal , pre-labor CS is a safe procedure although intrapartum CS and operative vaginal delivery are associated with increased risks in mothers and infants . Further research is needed to determine what aspects of obstetric care contribute to a delay in the provision of intrapartum interventions so that practice s may be made safer when they are needed BACKGROUND : The aim of this cohort , prospect i ve study was to compare the diagnostic value of intrapartum fetal pulse oximetry ( FPO ) with that of fetal scalp blood gas ( FSBG ) for an abnormal neonatal outcome in cases with abnormal fetal heart rate ( FHR ) tracings . METHODS : Fetal oxygen saturation was continuously monitored with Nellcor N-400 FPO during labor . Simultaneous FSBG determinations were obtained . The results were analyzed in relation to umbilical arterial cord blood pH and neonatal outcome . Studied FPO cutoff levels were 30 and 40 % hemoglobin saturation and that of FSBG pH was 7.2 . RESULTS : During the study , there were 9825 deliveries ; 415 had abnormal FHR . Only 150 fulfilled the whole screening panel . When the outcome variable was umbilical arterial pH , the positive predictive values of the three methods ( FPO30 , FPO40 , FSBG ) were 57 , 61 and 65 % and the negative predictive values were 43 , 39 and 35 % respectively . The sensitivity of FPO30 was highest ( 75 % ) . Considering abnormal neonatal outcome , again the sensitivity was also highest for FPO30 ( 89 % ) . The sensitivity of FSBG was 82 % . The specificity of the three methods were 53 , 49 and 38 % respectively . CONCLUSION : The diagnostic value of intrapartum FPO compares favorably with FSBG . FPO seems to be a reliable and less invasive tool and may decrease unnecessary interventions and unnecessary fetal scalp blood sampling in cases of suspected fetal distress . The FPO cutoff of 30 % saturation defined by previous studies appears to be appropriate As part of the Safe Motherhood Initiative , launched in 1987 , the World Health Organization have produced and promoted a partograph with a view to improving labour management and reducing maternal and fetal morbidity and mortality . This partograph has been tested in a multicentre trial in south east Asia involving 35,484 women . Introduction of the partograph with an agreed labour-management protocol reduced both prolonged labour ( from 6.4 % to 3.4 % of labours ) and the proportion of labours requiring augmentation ( from 20.7 % to 9.1 % ) . Emergency caesarean sections fell from 9.9 % to 8.3 % , and intrapartum stillbirths from 0.5 % to 0.3 % . Among singleton pregnancies with no complicating factors , the improved outcome was even more marked , with caesarean sections falling from 6.2 % to 4.5 % . The improvements took place among both nulliparous and multiparous women . The World Health Organisation partograph clearly differentiates normal from abnormal progress in labour and identifies those women likely to require intervention . Its use in all labour wards is recommended Objectives In re source -poor setting s , the st and ard of care to inform labour management is the partograph plus Pinard stethoscope for intermittent fetal heart rate ( FHR ) monitoring . We compared FHR monitoring in labour using a novel , robust wind-up h and held Doppler with the Pinard as a primary screening tool for abnormal FHR on perinatal outcomes . Design Prospect i ve equally r and omised clinical trial . Setting The labour and delivery unit of a teaching hospital in Kampala , Ug and a. Participants Of the 2042 eligible antenatal women , 1971 women in active term labour , following uncomplicated pregnancies , were r and omised to either the st and ard of care or not . Intervention Intermittent FHR monitoring using Doppler . Primary outcome measures Incidence of FHR abnormality detection , intrapartum stillbirth and neonatal mortality prior to discharge . Results Age , parity , gestational age , mode of delivery and newborn weight were similar between study groups . In the Doppler group , there was a significantly higher rate of FHR abnormalities detected ( incidence rate ratio (IRR)=1.61 , 95 % CI 1.13 to 2.30 ) . However , in this group , there were also higher though not statistically significant rates of intrapartum stillbirths ( IRR=3.94 , 0.44 to 35.24 ) and neonatal deaths ( IRR=1.38 , 0.44 to 4.34 ) . Conclusions Routine monitoring with a h and held Doppler increased the identification of FHR abnormalities in labour ; however , our trial did not find evidence that this leads to a decrease in the incidence of intrapartum stillbirth or neonatal death . Trial registration number Clinical Trails.gov ( 1000031587 ) OBJECTIVES To find out the incidence , outcome as well as antenatal , intrapartum and neonatal attributes of meconium stained amniotic fluid ( MSAF ) . DESIGN Prospect i ve study . SETTING Neonatal Unit of Hospital . SUBJECTS 1426 live births occurring in 1500 consecutive deliveries , over one year period . INTERVENTIONS In all babies born through MSAF , thorough oropharyngeal suction as soon as the head was delivered followed by immediate intratracheal intubation and suctioning in infants depressed at birth . RESULTS 204 ( 14.3 % ) deliveries had MSAF of which thick meconium was present in 141 . Hepatitis in mother , fetal distress during labor and intrauterine growth retardation were significant factors associated with MSAF . One fifth of babies born through MSAF suffered severe birth anoxia compared to 5.6 % in non-MSAF group . The consistency of meconium had direct bearing on the neonatal outcome . Severe birth asphyxia ( SBA ) occurred in 27.0 and 6.3 % of babies with thick and thin meconium staining , respectively . Meconium aspiration syndrome was observed in 9 babies of thick meconium group and 8 of these were depressed at birth . All deaths occurred in thick meconium group and were associated with SBA . CONCLUSIONS Selective approach can be adopted for babies with MSAF reserving intratracheal suctioning at birth for depressed neonate or evidence of fetal distress in u 
    Output:
    
Use of the partograph improved perinatal outcomes .
Several tests on admission ( admission tests ) and adjunctive tests including foetal stimulation tests improved the accuracy of foetal heart rate monitoring in predicting adverse perinatal outcomes .