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Geneva, Switzerland, World Health Organization [WHO], Division of Family Health, Maternal Health and Safe Motherhood Programme, 1992. iii, 46 p. (WHO/MCH/MSM/92.3)WHO's Maternal Health and Safe Motherhood Programme has guidelines for health workers to detect early signs and symptoms of preeclampsia and to provide early treatment of mild preeclampsia to prevent severe preeclampsia. Health workers must take accurate blood pressure measurements, test for protein in urine, and identify substantial edema. This manual helps them determine when blood pressure equipment does not work accurately and know how to fix it. The manual covers all parts of the sphygmomanometer (blood pressure machine): the cuff, rubber bladder, the aneroid sphygmomanometer, stethoscope, and pump and control valve. Health workers should know that certain conditions elevate blood pressure in normal patients. They can alleviate them to obtain accurate blood pressure measurements. These conditions are fear, cold, full urinary bladder, exercise, tight clothes around the arm, obesity, standing up, and lying on the back. Health workers should place either the left or right arm on a table or on another object thereby allowing the muscles to relax. The upper arm needs to be at the same level of the heart. It is important that all levels of health workers be adequately trained in taking blood pressures correctly. Training should not occur in busy and noisy clinics. The trainer should use a double stethoscope to determine whether the trainees correctly identify the Korotkoff sounds. Health workers must feel pregnant women how to collect a midstream urine sample, free of vaginal secretions and discharges, so the health workers can test for protein in the urine. Its presence indicates kidney failure. Diagnosis of mild preeclampsia includes a blood pressure at least 140/90 mmHg or an increase of 30 mmHg systolic or 15 mmHg diastolic and at least 300 g/l protein in urine. In addition to these signs, sudden onset of edema of face and/or hands, severe headaches, great reduction of urine output, epigastric pain, visual disturbances, and reduced fetal movement are reliable signs of severe preeclampsia.
WOMEN'S GLOBAL NETWORK FOR REPRODUCTIVE RIGHTS NEWSLETTER. 1991 Jul-Sep; (36):21-2.A meeting in Singapore of principal investigators from 7 countries in a WHO collaborative study on hypertensive disease of pregnancy, also called pre-eclampsia or eclampsia, pointed out women at risk, suggested management guidelines, and summarized operations research projects involving administration of aspirin or calcium supplements. Hypertensive disease of pregnancy may ultimately end in fatal seizures. It is often marked by warning signs of severe headaches and facial and peripheral edema. A survey in Jamaica found that 0.72% of a group of 10,000 pregnant women had eclamptic seizures. These were the cause of almost one-third of all obstetric deaths in the period 1981-1983. 10.4% of the pregnant women had hypertension, and half of these had proteinuria. Associated risk factors were primigravida, age >30, abnormal weight gain, edema, 1+ proteinuria. A phased program of management guidelines for identifying and treating affected women is being instituted in half of Jamaica's parishes. An operations research project involves administration of low-dose aspirin vs. placebo. Another controlled trial, in Peru, is testing calcium supplements. A third trial in Argentina will compare 2 drug regimens.