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BMC Pregnancy and Childbirth. 2017 Jun 19; 17(1):194.BACKGROUND: WHO proposed the WHO Maternal Near Miss (MNM) tool, classifying women according to several (potentially) life-threatening conditions, to monitor and improve quality of obstetric care. The objective of this study is to analyse merged data of one high- and two low-resource settings where this tool was applied and test whether the tool may be suitable for comparing severe maternal outcome (SMO) between these settings. METHODS: Using three cohort studies that included SMO cases, during two-year time frames in the Netherlands, Tanzania and Malawi we reassessed all SMO cases (as defined by the original studies) with the WHO MNM tool (five disease-, four intervention- and seven organ dysfunction-based criteria). Main outcome measures were prevalence of MNM criteria and case fatality rates (CFR). RESULTS: A total of 3172 women were studied; 2538 (80.0%) from the Netherlands, 248 (7.8%) from Tanzania and 386 (12.2%) from Malawi. Total SMO detection was 2767 (87.2%) for disease-based criteria, 2504 (78.9%) for intervention-based criteria and 1211 (38.2%) for organ dysfunction-based criteria. Including every woman who received >/=1 unit of blood in low-resource settings as life-threatening, as defined by organ dysfunction criteria, led to more equally distributed populations. In one third of all Dutch and Malawian maternal death cases, organ dysfunction criteria could not be identified from medical records. CONCLUSIONS: Applying solely organ dysfunction-based criteria may lead to underreporting of SMO. Therefore, a tool based on defining MNM only upon establishing organ failure is of limited use for comparing settings with varying resources. In low-resource settings, lowering the threshold of transfused units of blood leads to a higher detection rate of MNM. We recommend refined disease-based criteria, accompanied by a limited set of intervention- and organ dysfunction-based criteria to set a measure of severity.
New York, New York, UN Women, . 7 p. (Policy Brief No. 1)UN Women’s project "Promoting and Protecting Women Migrant Workers’ Labour and Human Rights: Engaging with International, National Human Rights Mechanisms to Enhance Accountability" is a global project funded by the European Union (EU) and anchored nationally in three pilot countries: Mexico, Moldova, and the Philippines. The project promotes women migrant workers’ rights and their protection against exclusion and exploitation at all stages of migration. One of the key results of the project has been the production of high-quality knowledge products. These have provided the foundation of the project’s advocacy and capacity building objectives. This Brief draws from the project’s knowledge products and provides an overview of the key situational and policy concerns for women migrant workers in each of the three pilot countries.
BJOG. 2018 Feb; 125(3):288.Against a background of an increasing demand for surgical intervention for the treatment of FGM/C related complications, Berg et al
Note for typesetter: Please update reference when assigned to an issue.have conducted a systematic review of 62 studies involving 5829 women, to assess the effectiveness of defibulation, excision of cysts and clitoral reconstructive surgery. Berg et al report that defibulation showed a lower risk of Caesarean section and perineal tears; excision of cysts commonly resulted in resolution of symptoms; and clitoral reconstruction resulted in most women self-reporting improvements in their sexual health. However, Berg et al highlight that they had little confidence in the effect estimate for all outcomes as most of the studies were observational and conclude that there is currently poor quality of evidence on the benefits and/or harm of surgical interventions to be able to counsel women appropriately. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Swiss Medical Weekly. 2017 Jun 21; 147:w14432.PURPOSE: Sayana(R) was introduced as the first depot medroxyprogesterone acetate-containing contraceptive that is administered via subcutaneous injection. Within 10 months, the Regional Pharmacovigilance Centre (RPVC) Zurich received several anonymous reports of serious local reactions after Sayana(R) administration. In this retrospective study, individual case safety reports (ICSRs) on local adverse drug reactions (ADRs) related to Sayana(R) were analysed from the WHO pharmacovigilance database. METHODS: International, national and regional ICSRs during Sayana(R) administration up to 1 January 2016 were examined. Data on ADRs were retrieved from the WHO Global Database VigiBase. Demographic data, drug administration information, duration of Sayana(R) treatment, latency time of the ADR, and its course, severity and outcomes were analysed. RESULTS: Worldwide, 398 ICSRs after Sayana(R) use were registered in the database. We identified 20 reported terms that were potentially used to describe a persistent lipodystrophy. When only cases containing one or more of these 20 reported terms were selected, 323 (81.2%) international ICSRs remained for analysis. Of those, 91.6% (n = 296) were categorised as serious. The majority of the reactions (n = 193, 54.4%) did not recover. In the 67 Swiss ICSRs, 77 ADRs were reported using 10 different terms including severe or persistent local reactions like lipodystrophy, atrophy or fat necrosis. Thirty-two patients (47.7%) did not recover. All 11 regional cases reported to the RPVC Zurich were categorised as serious ADRs. For the majority of the patients (n = 7, 63.6%) the interval between the application of Sayana(R) and development of the lipodystrophy was between 2 and 4 months. Most of the reactions were irreversible (n = 9, 81.8%). One patient underwent plastic surgery for artificial infill of the dent. CONCLUSIONS: Persistent local injection site reactions such as lipodystrophy, fat tissue necrosis or atrophy occur frequently after subcutaneous Sayana(R) use. These adverse drug reactions were recently integrated in the Swiss product information. Physicians and patients should be informed and advised about these potentially irreversible effects.
Response to 'WHO classification of FGM omission and failure to recognise some women's vulnerability to cosmetic vaginal surgery'
Journal of Family Planning and Reproductive Health Care. 2017 Feb 24; 1.Add to my documents.