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  1. 1

    Hypertensive diseases of pregnancy.


    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.
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  2. 2

    Maternal care for the reduction of perinatal and neonatal mortality. A joint WHO/UNICEF statement.

    World Health Organization [WHO]; UNICEF

    Geneva, Switzerland, WHO, 1986. 22 p.

    Maternal care is the most appropriate target for reducing the high perinatal and neonatal mortality typical of the least developed countries. The principles formulated by the 25th session of the WHO/UNICEF Joint Committee on Health Policy in 1985 are outlined here. Perinatal mortality is defined as infant death from 1000 g, even if intrauterine or stillborn, to 1 week of age. Neonatal mortality is that occurring in the 1st month of life. Half of infant mortality (up to 1 year of age) occurs in the 1st month, most of that during the 1st week, and these deaths are directly related to maternal care during pregnancy and delivery. They are caused by low birth weight, intrauterine or birth asphyxia, birth trauma, or infections, usually of the cord or amniotic fluid. Tetanus is the primary lethal infection. Tetanus can be prevented by immunizing women, or giving tetanus toxoid to pregnant women, but also very effectively by training birth assistants in hygiene. Traumatic deaths can best be prevented by training midwives and strengthening the support system for referral to clinics. The most cost-effective strategies for improving maternal health are nutritional intervention, malaria prevention, treatment of infections and of toxemia, reducing heavy workload of pregnant women, and family planning services. Points where community involvement is effective are discussed. WHO and UNICEF will increase support in health education, tetanus immunization, training of birth attendants, equipping birth facilities, appropriate technology, and operational research.
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