Ishaque et al. BMC Public Health 2011, 11(Suppl 3):S3 http://www.biomedcentral.com/1471-2458/11/S3/S3 associated with an infection, while only 2% of term still- births were infection-related [4]. Direct infection, pla- cental damage, and severe maternal illness are the most commonly reported mechanisms by which infections may cause stillbirths [5]. Among infections, various organisms have been impli- cated as causing stillbirth, including bacteria, viruses, pro- tozoa, helminthes and fungi [6]. Syphilis remains an avoidable cause of infection related stillbirths Plasmodium falciparum malaria has been associated with stillbirth espe- cially in primigravidas owing to its high prevalence and extensive placental damage [7]. TORCH infections, which include Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections, are infections during pregnancy that are associated with congenital anomalies and possibly still- births [8,9]. Most of the TORCH infections cause mild maternal morbidity, but have serious fetal consequences [8]. Periodontal disease is another important chronic infec- tious disease of humans which is commonly present in pregnancy [10]. It’s prevalence range from 35 to 100% (especially gingivitis) during pregnancy [11]. The risk of adverse pregnancy outcomes including preterm birth, fetal growth restriction may be increased in women with period- ontal disease [12-15]. This may be the result of systemic inflammatory responses due to a persistent periodontal infection, or periodontal disease may be a marker for infec- tion elsewhere in the body [12,16]. Helminthiasis is infesta- tion of the human body by parasitic worms [17]. Millions of pregnant women globally are infected with intestinal nematodes [18] which leads to chronic blood loss, and can be a major cause of iron deficiency anemia in reproductive age, which is a risk factor for adverse perinatal outcome [19]. A more detailed description of background literature on maternal infections during pregnancy and their associa- tion with stillbirths is given in Additional File 1. The objective of this review was to synthesize up-to-date evidence on the role of diagnosis and management of infections in pregnancy and their effects on stillbirth. This paper is a part of series of papers reviewing the effect of interventions to be included in the Live Saved Tool (LiST) [20]. This process involves qualitative assessment of avail- able evidence according to the Grading of Recommenda- tions, Assessment, Development and Evaluation (GRADE) approach and quantitative analysis based on rules devel- oped by the Child Health Epidemiology Reference Group (CHERG) [20,21]. More details about CHERG methods and LiST are available in the methods section of this paper and the CHERG methods paper [20]. Methods Literature search We searched all relevant literature on interventions dealing with infections during pregnancy to quantify Page 2 of 12 their impact on stillbirths and perinatal mortality. The last date of the search was February 1st 2010. The fol- lowing infections were included in this review: syphilis, P. falciparum malaria, HIV, bacterial vaginosis, ascend- ing bacterial infections (chorioamnionitis), asymptomatic bacteriuria, periodontal disease, helminthiasis, and TORCH infections. The databases searched included PubMed, the Cochrane Library, The Lancet Series and hand search of bibliographies of relevant reviews. Experts were also contacted in the field for unpublished data. The search strategy for different infections is given in Additional File 2: Selection (inclusion/exclusion criteria) The study designs primarily considered were rando- mized and quasi-randomized trials however observa- tional studies were also considered where data were not available from randomized trials. There was no restric- tion on language or publication status. There were no limits on gestational age at the time of enrolment in the study. For IPTp (intermittent preventive treatment of P. Falciparum), we sought studies that measured the effect of at least 2-doses per pregnancy of IPTp with sulfadoxine-pyrimethamine versus a placebo, indepen- dent of Insecticide treated nets (ITNs). Trials that com- pared 2-doses of IPTp to another drug (not a placebo) were excluded, as were trials that assessed IPTp com- pared to ITNs where the effect of IPTp against a pla- cebo could not be isolated. For ITNs, we sought studies that measured the effect of access to ITNs among preg- nant women versus no ITNs on stillbirths. Trials that compared ITNs to untreated nets were excluded, as were trials that assessed ITNs plus IPTp where the effect of ITNs against no mosquito net (placebo) could not be isolated. Data abstraction and validity assessment Each study that satisfied the eligibility criteria was included in the review. A standardized data extraction sheet was used [20]. The data were abstracted for key variables like; participants’ characteristics, sample size, location, study design and limitations, description of intervention and control groups. The individual studies were graded according to CHERG adaptation of GRADE criteria [20]. A study was graded as that of ‘high’ ‘moderate’ ‘low’ or ‘very low’ qual- ity based on strengths and limitations of the study. Studies received an initial score of high if they were a randomized or cluster randomized trial. The grade was decreased one grade for each study design limitation. In addition, studies reporting an intent-to-treat analysis or with statistically significant strong levels of association (>80% reduction) received 0.5-1 grade increases. Any study with a final grade of very low was excluded. The