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Seminars In Perinatology. 2015 Oct; 39(6):430-6.Induction of labor in resource-limited settings has the potential to significantly improve health outcomes for both mothers and infants. However, there are relatively little context-specific data to guide practice, and few specific guidelines. Also, there may be considerable issues regarding the facilities and organizational capacities necessary to support safe practices in many aspects of obstetrical practice, and for induction of labor in particular. Herein we describe the various opportunities as well as challenges presented by induction of labor in these settings. Copyright (c) 2015 Elsevier Inc. All rights reserved.
Bulletin of the World Health Organization. 2014; 92:155.Unsafe abortion is defined by the World Health Organization (WHO) as a procedure for terminating a pregnancy as performed by persons lacking the necessary skills or in an inappropriate environment that fails to meet minimal medical standards, or both. Concepts first outlined in a 1992 WHO Technical Consultation are embodied in this definition. However, although this definition is widely used, it is inconsistently interpreted. In this editorial, we discuss its correct interpretation and operationalization. (excerpt)
Washington, D.C., Program for Appropriate Technology in Health [PATH], 2013.  p.This toolkit provides information about the UN Commission on Life-Saving Commodities (the Commission), 13 priority commodities, and examples of how its ten recommendations to improve access and availability are being applied globally and within countries. It also provides advocacy resources for utilizing the Commission platform to raise awareness and engage stakeholders in addressing commodity-related gaps in policy.
Geneva, Switzerland, WHO, Department of Reproductive Health and Research, 2011.  p. (WHO/RHR/11.10)The primary goal of the present guidelines is to improve the quality of care and outcomes for pregnant women undergoing induction of labour in under-resourced settings. The target audience of these guidelines includes obstetricians, midwives, general medical practitioners, health-care managers and public health policy-makers. The guidance provided is evidence-based and covers selected topics related to induction of labour that were regarded as critical priority questions by an international, multidisciplinary group of health-care workers, consumers and other stakeholders. This evidence base includes chapters on indications, methods, treatment of uterine hyperstimulation and setting.
Geneva, Switzerland, WHO, 2011.  p.The primary goal of the present guidelines is to improve the quality of care and outcomes for pregnant women undergoing induction of labour in under-resourced settings. The target audience of these guidelines includes obstetricians, midwives, general medical practitioners, health-care managers and public health policy-makers. The guidance provided is evidence-based and covers selected topics related to induction of labour that were regarded as critical priority questions by an international, multidisciplinary group of health-care workers, consumers and other stakeholders.
Applying the WHO strategic approach to strengthening first and second trimester abortion services in Mongolia.
Reproductive Health Matters. 2008 May; 16(31 Suppl):127-34.Abortion was made legal on request in Mongolia in 1989, following the collapse of the socialist regime, and later bound by a range of regulations. Concerned about the high number of abortions and inadequate quality of care in abortion services, the Ministry of Health applied the World Health Organization's Strategic Approach to issues related to abortion and contraception in 2003. The aim was to develop policies and programmes to reduce unintended pregnancies, mitigate complications from unsafe abortion, and improve the quality of abortion and contraception services for all socio-economic groups, including adolescents. This paper describes the changes that arose from a strategic assessment, highlighting the introduction of mifepristone-misoprostol for second trimester abortion. The aim was to replace mini-caesarean section and intra-uterine injection of Rivanol (ethacridine lactate), so that second trimester abortions could take place earlier than at 20 weeks gestation. National standards and guidelines for comprehensive abortion care were developed, the national pre-service training curriculum was harmonized with the new guidelines, at least one-third of the country's obstetrician-gynaecologists were trained in manual vacuum aspiration and medical abortion, and three model comprehensive abortion care units were established to provide high quality services to women, high quality training for providers and serve as nodes for further scaling up.
Lancet. 2005 May 28; 365(9474):1826.More than 2 months after a WHO expert committee recommended that mifepristone and misoprostol should be added to its Essential Medicines list, the file is still awaiting sign-off. A spokesperson for the Department of Medicines Policy and Standards within WHO told The Lancet that it was a “political matter”. We were urged to speak to the Director-General’s office; a spokesperson said she had no idea when a decision would be made. Every day’s delay results in women dying unnecessarily from complications of surgical abortions or use of unsafe medical methods for pregnancy termination. According to WHO statistics, 19 million women have an unsafe abortion worldwide every year; 18.5 million of these occur in developing countries. Deaths due to unsafe abortion are estimated to number around 68,000 a year. (excerpt)
WHO multicentre randomised trial of misoprostol in the management of the third stage of labour. [Estudio clínico multicéntrico aleatorizado de la OMS sobre misoprostol en el manejo del alumbramiento]
Lancet. 2001 Sep 1; 358(9283):689-95.Postpartum hemorrhage is a leading cause of maternal morbidity and mortality. Active management of the third stage of labor, including use of uterotonic agent, has been shown to reduce blood loss. Misoprostol (a prostaglandin E1 analogue) has been suggested for this purpose because it has strong uterotonic effects, can be given orally, is inexpensive, and does not need refrigeration for storage. The authors did a multicenter, double- blind, randomized controlled trial to determine whether oral misoprostol is as effective as oxytocin during the third stage of labor. In hospitals in Argentina, China, Egypt, Ireland, Nigeria, South Africa, Switzerland, Thailand, and Vietnam, the authors randomly assigned women about to deliver vaginally to receive 600 mcg misoprostol orally or 10 IU oxytocin intravenously or intramuscularly, according to routine practice, plus corresponding identical placebos. The medications were administered immediately after delivery as part of the active management of the third stage of labor. The primary outcomes were measured postpartum blood loss of 1000 ml or more, and the use of additional uterotonics without an unacceptable level of side-effects. The authors chose an upper limit of a 35% increase in the risk of blood loss of 1000 ml or more as the margin of clinical equivalence, which was assessed by the confidence interval of the relative risk. Analysis was by intention to treat. 9264 women were assigned misoprostol and 9266 oxytocin. 37 women in the misoprostol group and 34 in the oxytocin group had emergency caesarean sections and were excluded. 366 (4%) of women on misoprostol had a measured blood loss of 1000 ml or more, compared with 263 (3%) of those on oxytocin (relative risk 1.39 [95% confidence interval 1.19-1.63], p < 0.0001). 1398 (15%) women in the misoprostol group and 1002 (11%) in the oxytocin group required additional uterotonics (1.40 [1.29-1.51], p < 0.0001). Misoprostol use was also associated with a significantly higher incidence of shivering (3.48 [3.15- 3.84]) and raised body temperature (7.17 [5.67-9.07]) in the first hour after delivery. 10 IU oxytocin (intravenous or intramuscular) is preferable to 600 mcg oral misoprostol in the active management of the third stage of labor in hospital settings where active management is the norm. (author's)