Perinatal care - dimensions and approaches to improve quality of care in developing countries

Background: Despite significant progress in reduction in neonatal mortality, perinatal mortality in India is relatively stagnant. There is also mismatch between quantitative gain in the institutional delivery and reduction in maternal and perinatal mortality. Quality of care has emerged as a critical determinant of facility level care for perinatal, neonatal and maternal outcomes. This systematic review attempted at improving the understanding on the determinants, influencers and potential interventions that improve these health outcomes. Materials & Methods: A PubMed database search was done using MeSH terms including quality of care, perinatal care, India, hospital, intrapartum care, implementation & still birth for period 2006 to 2016. A narrative synthesis of the objectives and results was done. Results: Out of the 3715 articles, 19 articles were found suitable for review. The findings were synthesized under four broad domains and 14 sub-domains. Majority of the patients attending public health facilities were unaware of the standards of services with minimal expectation, thus perceived whatever available as good. The infrastructural, staff availability, attitude and behavior were factors for low client satisfaction. Off-hours and weekend deliveries had higher adverse perinatal outcome. Deliveries at busy hospitals and higher institutional delivery didn't proportionately reduce perinatal mortality. Sub-optimal antenatal care, obstructed labour, delayed care seeking and referral were risk factors for perinatal outcome. Perinatal death audit, capacity building and checklists have positive impact on outcomes. Conclusions: Although the broad risk factors and determinants of perinatal outcome are known, appropriate context specific adaptation of intervention is needed for improving the perinatal survival.