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  1. 1

    WHO recommendations on antenatal care for a positive pregnancy experience.

    World Health Organization [WHO]. Department of Reproductive Health and Research; World Health Organization [WHO]. Department of Nutrition for Health and Development; World Health Organization [WHO]. Department of Maternal, Newborn, Child and Adolescent Health

    Geneva, Switzerland, WHO, 2016. 172 p.

    The World Health Organization has released a new set of antenatal care (ANC) recommendations to improve maternal and perinatal health worldwide. The guidelines seek to reduce the global burden of stillbirths, reduce pregnancy complications and provide all women and adolescents with a positive pregnancy experience. High quality health care during pregnancy and childbirth can prevent deaths from pregnancy complications, perinatal deaths and stillbirths, yet globally, less than two-thirds of women receive antenatal care at least four times throughout their pregnancy. The new ANC model raises the recommended number of ANC visits from four to eight, thereby increasing the number of opportunities providers have to detect and address preventable complications related to pregnancy and childbirth. The guidelines provide 49 recommendations for routine and context-specific ANC visits, including nutritional interventions, maternal / fetal assessments, preventive measures, interventions for common physiological symptoms and health system interventions. Given that women around the world experience maternal care in a wide range of settings, the recommendations also outline several context-specific service delivery options, including midwife-led care, group care and community-based interventions.
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  2. 2

    WHO Technical Consultation on Postpartum and Postnatal Care.

    Matthews M; Severin VX; Jelka Z

    Geneva, Switzerland, World Health Organization [WHO], Department of Making Pregnancy Safer, 2010. [65] p. (WHO/MPS/10.03)

    On October 29, 2008, WHO Technical Consultation on Postpartum and Postnatal Care was held in Geneva, Switzerland. This report reflects the discussions, proceedings and recommendations for follow-up. The World Health Organization (WHO) is in the process of revising and updating its guidance on postpartum and postnatal care delivered by skilled providers. The purposes of the revision are to encourage and support broader provision of care and to foster a new, woman-centred concept of care that promotes health and sustains attention to dangerous complications. This consultation report also discusses follow up activities after the revision of the WHO guidance.
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  3. 3

    Frequently asked clinical questions about medical abortion.

    International Consensus Conference on Non-surgical (Medical) Abortion in Early First Trimester on Issues Related to Regimens and Service Delivery (2004: Bellagio)

    Geneva, Switzerland, World Health Organization [WHO], 2006. 35 p.

    On 1--5 November 2004, in Bellagio, Italy, the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), organized a meeting entitled International Consensus Conference on Non-surgical (Medical) Abortion in Early First Trimester on Issues Related to Regimens and Service Delivery. This document is the result of the deliberations of the participants in that meeting, who included highly experienced researchers and clinicians in the area of medical abortion. Prior to the meeting health-care personnel providing abortion services in various countries were asked to provide a list of the most frequently asked questions about medical abortion. The meeting participants reviewed those questions and compiled answers to them based on the scientific literature and their own clinical experience. The answers are presented in this publication. (excerpt)
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  4. 4

    The use of rapid syphilis tests.

    World Health Organization [WHO]. Special Programme for Research and Training in Tropical Diseases. Sexually Transmitted Diseases Diagnostics Initiative

    Geneva, Switzerland, WHO, Special Programme for Research and Training in Tropical Diseases [TDR], 2006. 25 p. (TDR/SDI/06.1.)

    Syphilis is a curable infection caused by a bacterium called Treponema pallidum. This infection is sexually transmitted, and can also be passed on from a mother to her fetus during pregnancy. As a cause of genital ulcer disease, syphilis has been associated with an increased risk of HIV transmission and acquisition. Most persons with syphilis tend to be unaware of their infection and they can transmit the infection to their sexual contacts or, in the case of a pregnant woman, to her unborn child. If left untreated, syphilis can cause serious consequences such as stillbirth, prematurity and neonatal deaths. Adverse outcomes of pregnancy are preventable if the infection is detected and treated before mid-second trimester. Early detection and treatment is also critical in preventing severe long term complications in the patient and onward transmission to sexual partners. Congenital syphilis kills more than one million babies a year worldwide but is preventable if infected mothers are identified and treated appropriately as early as possible. (excerpt)
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  5. 5

    Medical eligibility criteria for contraceptive use. 3rd ed.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, Department of Reproductive Health and Research, 2004. [197] p.

    This document is one important step in a process for improving access to quality of care in family planning by reviewing the medical eligibility criteria for selecting methods of contraception. It updates the second edition of Improving access to quality care in family planning: medical eligibility criteria for contraceptive use, published in 2000, and summarizes the main recommendations of an expert Working Group meeting held at the World Health Organization, Geneva, 21-24 October 2003. (Please see Annex 2 for the list of participants.) The Working Group brought together 36 participants from 18 countries, including representatives of many agencies and organizations. The document provides recommendations for appropriate medical eligibility criteria based on the latest clinical and epidemiological data and is intended to be used by policy-makers, family planning programme managers and the scientific community. It aims to provide guidance to national family planning/reproductive health programmes in the preparation of guidelines for service delivery of contraceptives. It should not be seen or used as the actual guidelines but rather as a reference. The document covers the following family planning methods: low-dose combined oral contraceptives (COCs), combined injectable contraceptives (CICs), combined patch (P), combined vaginal ring (R), progestogen-only pills (POPs), depot medroxyprogesterone acetate (DMPA), norethisterone enantate (NET-EN), levonorgestrel (LNG) and etonogestrel (ETG) implants, emergency contraceptive pills (ECPs), copper intrauterine devices (Cu- IUDs), levonorgestrel-releasing IUDs (LNG-IUDs), copper-IUD for emergency contraception (E-IUD), barrier methods (BARR), fertility awareness-based methods (FAB), lactational amenorrhoea method (LAM), coitus interruptus (CI), and female and male sterilization (STER). (excerpt)
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  6. 6

    HIV prevention in maternal health services: training guide.

    Perchal P; Mielke E; Kaniauskene A; Verbel LB

    New York, New York, United Nations Population Fund [UNFPA], 2004. [126] p.

    The goal of this training is to build the capacity of programme managers and staff to address pregnant and postpartum clients’ HIV and STI needs by offering integrated HIV and STI services within their own particular service-delivery setting. The general objectives of this curriculum are to ensure that by the end of the training, the participants will have the knowledge, attitudes, and skills necessary to carry out the following key prevention tasks: 2 Help clients assess their own needs for a range of HIV and STI services, information, and emotional support. 2. Provide clear and correct information appropriate to clients’ identified concerns and needs. 3 Assist clients in making their own voluntary and informed decisions about HIV nad STI risk reduction. 4. Help clients develop the skills they will need to carry out those decisions. (excerpt)
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  7. 7

    HIV prevention in maternal health services: programming guide.

    Perchal P; Farrell B; Koumpounis A; Galvão L; Mielke E

    New York, New York, United Nations Population Fund [UNFPA], 2004. [148] p.

    While this guide primarily addresses HIV prevention, it also makes the link to other STI’s, since these can increase a pregnant woman’s succeptibility to HIV infection and since both HIV/AIDS and other STI’s can be transmitted to the foetus or newborn child. While preventing HIV infection in pregnant women is a critical element in preventing HIV transmission to the child (vertical transmission), this guide does not attempt to duplicate the many training aides and programme guides that already address prevention of vertical transmission. Prevention of mother-to-child transmission (PMTCT) is more than the provision of antiretroviral drugs to prevent transmission of HIV from an HIV-positive woman to her infant. A comprehensive programme to prevent HIV transmission to pregnant women, mothers, and their children, which has been endorsed by the UN system, includes four elements known as PMTCT, defined as: 1. Prevention of HIV, especially among young people and pregnant women. 2. Prevention of unintended pregnancies among HIV-infected women. 3. Prevention of HIV transmission from HIV-infected women to their infants. 4. Provision of treatment, care, and support to HIV-infected women and their families. This guide focuses primarily on the first of the four elements. (excerpt)
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  8. 8

    Strategic guidance on HIV prevention.

    United Nations Population Fund [UNFPA]

    New York, New York, UNFPA, 2001. 32 p. (Preventing HIV / Promoting Reproductive Health)

    UNFPA has worked in the field of population and development for more than three decades and has addressed the issue of HIV/AIDS for the last decade. However, no organization by itself has the capacity or the resources needed to address and halt the pandemic. An effective response requires careful collaboration and coordination among organizations, with each bringing to the partnership a distinct set of capabilities, strengths and comparative advantages. As one of the eight cosponsors of UNAIDS (the other cosponsors being UNICEF, UNDP, UNDCP, UNESCO, ILO, WHO and World Bank), UNFPA chairs Theme Groups in many countries and supports HIV-prevention interventions in almost all of its country programmes. To maximize its response and to strengthen coordinated activities with other partners, it is critical for staff at every level to have a common understanding of the Fund’s policies and strategic priorities. The aim of this document is to provide such guidance to staff, delineating the niche in which UNFPA as an organization has a definite comparative advantage in addressing the HIV/AIDS epidemic, especially at the country level. (excerpt)
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  9. 9

    Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: guidelines on care, treatment and support for women living with HIV / AIDS and their children in resource-constrained settings.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2004. v, 49 p.

    Mother-to-child transmission (MTCT) is the most important source of HIV infection in children. In 2001, the United Nations General Assembly Special Session on HIV/AIDS committed countries to reduce the proportion of infants infected with HIV by 20% by 2005 and by 50% by 2010. Achieving this urgently requires an increase in access to integrated and comprehensive programmes to prevent HIV infection in infants and young children. Such programmes consist of interventions focusing on primary prevention of HIV infection among women and their partners; prevention of unintended pregnancies among HIV-infected women; prevention of HIV transmission from HIV-infected women to their children; and the provision of treatment, care and support for women living with HIV/AIDS, their children and families. WHO convened a Technical Consultation on Antiretroviral Drugs and the Prevention of Mother-to-child Transmission of HIV Infection in Resource-limited Settings in Geneva, Switzerland on 5–6 February 2004. Scientists, policymakers, programme managers and community representatives reviewed the most recent experience with programmes and evidence on the safety and efficacy of various antiretroviral (ARV) regimens for preventing HIV infection in infants. This information was reviewed in the context of the rapid expansion of ARV treatment in resource-constrained settings using standardized and simplified drug regimens. Prior to the Technical Consultation, a draft set of recommendations had been issued for public comment. (excerpt)
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  10. 10

    WHO antenatal care randomized trial: Manual for the implementation of the new model. [Estudio clínico aleatorizado de control prenatal de la OMS: Manual para la puesta en práctica del nuevo modelo]

    Villar J; Bergsjo P

    Geneva, Switzerland, World Health Organization [WHO], 2002. 33 p.

    This manual describes the basic component of the new WHO antenatal care model. It provides detailed instructions on how to conduct the four-visit schedule of the basic component of the new WHO model. It includes a classifying form for easy assessment of a woman’s eligibility for the basic component, and provides a checklist of activities that are to be performed throughout the four-visit schedule. It is important to emphasize that the basic component of the new WHO antenatal care model is intended only for the management of pregnant women who do not have evidence of pregnancy-related complications, medical conditions or major health-related risk factors. For the management of women who have such conditions, health providers are advised to follow the recommended established procedures of their clinic or hospital. The clinics or hospitals that do not have established procedures for women with such conditions, or that wish to update the ones they currently have, can use The WHO Reproductive Health Library to identify evidence-based interventions. (author's)
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  11. 11

    Safe abortion: technical and policy guidance for health systems.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2003. 106 p.

    In October 2000,at the United Nations Millennium Summit, all countries agreed on the global imperative to reduce poverty and inequities. The need to improve maternal health was identified as one of the key Millennium Development Goals, with a target of reducing levels of maternal mortality by three-quarters between1990and2015. The causes of maternal deaths are multiple. Women die because complications during labour and delivery go unrecognised or are inadequately managed. They die from diseases such as malaria, that are aggravated by pregnancy. They die because of complications arising early in pregnancy, sometimes even before they are aware of being pregnant, such as ectopic pregnancy. And they die because they seek to end unwanted pregnancies but lack access to appropriate services. Achieving the Millennium Development Goal of improved maternal health and reducing maternal mortality requires actions on all these fronts. (author's)
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  12. 12

    Detecting pre-eclampsia: a practical guide. Using and maintaining blood pressure equipment.

    Guidotti R; Jobson D

    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.
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