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Managing complications in pregnancy and childbirth (MCPC): A guide for midwives and doctors. Highlights from the World Health Organization’s 2017 Second Edition.
[Geneva, Switzerland], WHO, 2017 May. 8 p. (WHO/MCA/17.02; USAID Cooperative Agreement No. AID-OAA-A-14-00028)Since it was first published in 2000, the World Health Organization’s (WHO’s) Managing Complications in Pregnancy and Childbirth (MCPC) manual has been used widely around the world to guide the care of women and newborns who have complications during pregnancy, childbirth and the immediate postnatal period. The MCPC manual targets midwives and doctors working in district-level hospitals. Selected chapters from the first edition of the MCPC were revised in 2016 based on new WHO recommendations, and the second edition of the MCPC manual is now available. This brief reviews the revision process and summarizes updated clinical guidelines for a subset of revised chapters, including: emotional and psychological support; hypertensive disorders of pregnancy; bleeding in early pregnancy and after childbirth; and prevention and management of infection in pregnancy and childbirth. (Excerpt)
Signs of eclampsia during singleton deliveries and early neonatal mortality in low- and middle-income countries from three WHO regions.
International Journal of Gynaecology and Obstetrics. 2017 Oct; 139(1):50-54.OBJECTIVE: To determine the prevalence of eclampsia symptoms and to explore associations between eclampsia and early neonatal mortality. METHODS: The present secondary analysis included Demographic and Health Surveys data from 2005 to 2012; details of signs related to severe obstetric adverse events of singleton deliveries during interviewees' most recent delivery in the preceding 5 years were included. Data and delivery history were merged for pooled analyses. Convulsions-used as an indicator for having experienced eclampsia-and early neonatal mortality rates were compared, and a generalized random effect model, adjusted for heterogeneity between and within countries, was used to investigate the impact of presumed eclampsia on early neonatal mortality. RESULTS: The merged dataset included data from six surveys and 55 384 live deliveries that occurred in Colombia, Bangladesh, Indonesia, Mali, Niger, and Peru. Indications of eclampsia were recorded for 1.2% (95% confidence interval [CI] 1.0-1.3), 1.7% (95% CI 1.5-2.1), and 1.7% (95% CI 1.5-2.1) of deliveries reported from the American, South East Asian, and African regions, respectively. Pooled analyses demonstrated that eclampsia was associated with increased risk of early neonatal mortality (adjusted risk ratio 2.1 95% CI 1.4-3.2). CONCLUSION: Increased risk of early neonatal mortality indicates a need for strategies targeting the early detection of eclampsia and early interventions. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
OS032. Pharmacotherapy for pre-eclampsia in low and middle income countries: An analysis of essential medicines lists (EMLS).
Pregnancy Hypertension. 2012 Jul; 2(3):193-4.INTRODUCTION: Pre-eclampsia is the second leading cause of maternal mortality in low and middle income countries (LMIC). Pharmacological management of pre-eclampsia has five major components including antihypertensive therapy for severe and non-severe hypertension, magnesium sulphate for prevention or treatment of eclampsia, treatment of pre-eclampsia-related end-organ complications, antenatal corticosteroids for acceleration of fetal pulmonary maturity given iatrogenic preterm delivery for maternal and/or fetal indications, and labour induction for such indicated deliveries. Essential medicines are defined by the World Health Organization (WHO) as "drugs that satisfy the health care needs of the majority of the population". Essential Medicines Lists (EMLs) detail these essential medicines within an individual country and support the argument that the medication should be routinely available. OBJECTIVES: To determine how many drugs required for comprehensive pre-eclampsia management are listed in national EMLs of LMIC. METHODS: We conducted a descriptive analysis of relevant drug prevalence on identified EMLs. We searched for the national EMLs of the 144 LMIC identified by the World Bank. EMLs were collected by broad based internet searches and in collaboration with the WHO. The EMLs were surveyed for therapies for the different aspects of pre-eclampsia management: hypertension (non-severe and severe with oral or parenteral agents), eclampsia, pre-eclampsia complications (e.g., pulmonary oedema, thrombosis), preterm birth, and labour induction. RESULTS: EMLs were located and reviewed for 58(40.3%) of LMIC. One or more parenteral antihypertensive agents were listed in 51(87.9%) EMLs. The most common agents were: hydralazine (67.2%), verapamil (58.6%), propranolol (39.7%) and sodium nitroprusside (37.9%); parenteral labetalol was listed by only 19.0% of EMLs. The most prevalent oral antihypertensive therapies listed were: nifedipine (96.6%, usually 10 or 20mg intermediate-acting tablets), methyldopa (94.8%), propranolol (89.7%), and atenolol (87.9%). Captopril, enalapril, hydrochlorothiazide and spironolactone were commonly listed. Magnesium sulphate for prevention and management of eclampsia was present in 86.2% of EMLs (and its antidote, calcium gluconate in 82.8%). To manage complications of pre-eclampsia, oral frusemide was listed in 94.8% of EMLs and parenteral heparin in 91.4%. Most EMLs listed parenteral dexamethasone (91.4%) for acceleration of fetal pulmonary maturity and oxytocin (98.3%) or a prostanoid (usually misoprostol, 39.7%) for labour induction. CONCLUSION: EMLs of LMIC provide comprehensive coverage of all aspects of recommended pre-eclampsia pharmacotherapy. These EMLs may be used as advocacy tools to ensure the availability of these therapies within each country. Copyright (c) 2012. Published by Elsevier B.V.
Acta Obstetricia et Gynecologica Scandinavica. 2003 Nov; 82(11):1063-1064.In these days of evidence-based medicine, whatever is done to provide evidence in favor or against a procedure, protocol, program, test or intervention is always welcomed. It is in this light that the new World Health Organization (WHO) antenatal care model, now being propagated for general implementation, will be assessed. The focus of the WHO antenatal model was the developing countries because it was rightly assumed that the routinely recommended antenatal care program is often poorly implemented and clinical visits can be irregular, with long waiting times and poor feedback to the women. A multicenter, randomized, control trial was therefore conducted to compare the old, standard "western" model of antenatal care with the new WHO model, which limits the number of visits to the clinic and restricts tests and clinical procedures. But this all-important study did not consider it appropriate to include at least one African country, with all the peculiarities of sub- Saharan Africa. Even then, out of the four chosen countries, Saudi Arabia, for instance, cannot be said to be a classic example of a developing country. The design of the study was therefore suspect from the outset! A closer look at the trial itself revealed more defects and debatable issues. For instance, the primary maternal outcome monitored was a maternal morbidity index, partly defined by eclampsia occurring within 24 h of delivery and severe postpartum anemia (hemoglobin <90 g/L). The issue of excluding eclamptics whose fits occur after 24 h of delivery might not be as controversial as labeling patients with hemoglobin of <90 g/L with severe anemia. Certainly there are many elegant studies that do not support that definition of severity, at least for African mothers. (excerpt)
Washington, D.C., Global Health Council, 2002 May. 20 p. (Technical Report)This document includes the following chapters: Towards an Evidence-Based Approach to Decision Making; Reducing Maternal Mortality Through Evidence-Based Treatment of Eclampsia; Reducing Postpartum Hemorrhage: Routine Use of Active Management of the Third Stage of Labor; The WHO Reproductive Health Library (RHL) Better Births Initiative: A Programme for Action in Middle- and Low-Income Countries; and Using Evidence to Save the Lives of Mothers.