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WHO recommendations for prevention and treatment of maternal peripartum infections: Highlights and key messages from the World Health Organization's 2015 global recommendations.
[Geneva, Switzerland], WHO, 2015 Sep.  p. (WHO/RHR/15.19; WHO/MCA/15.01)Bacterial infections around the time of childbirth account for about one-tenth of maternal deaths and contribute to severe morbidity and long-term disability for many affected women. Standard infection prevention and control measures are a cornerstone of peripartum infection prevention (e.g., hand hygiene and use of clean equipment). WHO recommendations for prevention and treatment of maternal peripartum infections include both recommended and non-recommended interventions during labour, childbirth, and the postpartum period. Clinical monitoring, early detection, and prompt treatment of peripartum infection with an appropriate antibiotic regimen are essential for reducing death and morbidity in affected women. Recommendations for antibiotic prophylaxis / treatment for specific indications balance health benefits for the mother and newborn with safety concerns (e.g., adverse effects) and the public health imperative to control antibiotic resistance.
Geneva, Switzerland, WHO, 2015.  p. (WHO/RHR/15.21)This document consists largely of GRADE: Grading of Recommendations Assessment, Development and Evaluation tables for studies on maternal peripartum infection prevention and treatment practices.
Geneva, Switzerland, WHO, 2015.  p.The goal of the present guideline is to consolidate guidance for effective interventions that are needed to reduce the global burden of maternal infections and their complications around the time of childbirth. This forms part of WHO’s efforts to improve the quality of care for leading causes of maternal death, especially those clustered around the time of childbirth, in the post-MDG era. Specifically, it presents evidence-based recommendations on interventions for preventing and treating genital tract infections during labour, childbirth or the puerperium, with the aim of improving outcomes for both mothers and newborns.The primary audience for this guideline is health professionals who are responsible for developing national and local health protocols and policies, as well as managers of maternal and child health programmes and policy-makers in all settings. The guideline will also be useful to those directly providing care to pregnant women, including obstetricians, midwives, nurses and general practitioners. The information in this guideline will be useful for developing job aids and tools for both pre- and inservice training of health workers to enhance their delivery of care to prevent and treat maternal peripartum infections. (Excerpts)
Breastfeeding, breast milk and human immunodeficiency virus (HIV). Statement from the Consultation held in Geneva, 23-25 June, 1987.
WHO REPORT. 1988; 1-2.Recommendations from a consultation on breastfeeding, breast milk and HIV infection held by the Global Programme on AIDS and the Division of Family Health of the WHO in June 1987 are summarized. 20 participants from 15 countries, experts in epidemiology, immunology, virology, pediatrics and nutrition attended. There is a 25-30% chance that HIV will be transmitted from mother to infant during the perinatal period. Whether HIV can be transmitted via breast milk is unknown and risk is thought to be small. While there is 1 report of HIV cultured from breast milk, and a few cases of mothers infected after delivery by blood transfusions who transmitted HIV to their infants by breastfeeding, there are many reports of infected mothers breastfeeding without infecting their infants. Breast milk is still the best food for infants for immunologic, nutritional, psychological and child-spacing benefits. It is recommended that breastfeeding continue to be promoted in both developing and developed countries, regardless of HIV status. The use of pooled human milk is the second best mode of infant feeding. Pasteurization at 56 degrees C. for 30 minutes will inactivate HIV. Wet nurses should be chosen with care.
Contraception. 1984 Dec; 30(6):505-22.The World Health Organization (WHO) conducted a randomized comparative trail of th effects of hormonal contrception on milk volume and infant growth. The 341 study participants, drawn from 3 obstetric centers in Hungary and Thailand, were 20-35 years of age with 2-4 live births and previous successful experience with breastfeeding. Subjects who chose oral contraception (OC) were randomly allocated to a combined preparation containing 150 mcg levonorgestrel and 30 mcg ethinyl estradiol (N=86) or to a progestin-only minipill containing 75 mcg dl-norgestrel (N=8). 59 Thai women receiving 150 mg depot medroxyprogesterone (DPMA) intramuscularly every 3 months were also studied. An additional 111 women who were using nonhormonal methods of contraception or no contraception served as controls. Milk volume was determined by breast pump expression. No significant differences in average milk volume were noted between treatment groups at the 6 week baseline visit. However, between the 6th and 24th weeks, average milk volume in the combined OC group declined by 41.9%, which was significantly greater than the declines of 12.0% noted in the progestin-only group, 6.1% among DMPA users, and 16.7% among controls. The lower expressed milk volume among combined OC users did not impair infant growth. No significant differences were observed between treatment groups in terms of average infant body weight or rate or weight gain. Users of combined OCs may have compensated for their decreased milk volume by providing more extensive supplementary feeding or more prolonged suckling episodes. These results suggest that the estrogen content of combined OCs adversely affects the capacity of the breast to produce milk; thus, family planning programs should make nonestrogen-containing methods available to breastfeeding mothers. Although no effects on infant growth were noted in this study, the possibility of such efects cannot be excluded in populations where infant growth largely depends on the adequacy of unsupplemente d lactation.
Maternal and child health indicators: implications of the tenth revision of the International Classification of Diseases.
Revista Panamericana de Salud Pública / Pan American Journal of Public Health. 1997 Jul; 2(1):13-7.This article describes the World Health Organization's most recent decennial revision of its International Statistical Classification of Diseases and Related Health Problems (ICD-10). Obstetrical tetanus is now included in the chapter on infectious diseases, which facilitates the recording of this cause of maternal death. The revision also includes new definitions, such as later maternal death (>42 days and <1 year after delivery), and the perinatal period as starting at 22 completed weeks of gestation and ending 7 completed days after birth. This change will have consequences for statistics involving stillbirths and perinatal mortality. Accordingly, perinatal mortality will increase, with corresponding consequences for trend studies. Chapter XV deals with pregnancy, childbirth, and the puerperium, with the number of categories increasing from 45 to 75. Other important categories are: obstetrical death of unspecified cause, and death from sequelae of direct obstetric causes. Chapter XVI pertains to certain conditions originating in the perinatal period and was expanded from 20 categories to 58, including "disorders related to length of gestation and fetal growth" and "infections specific to the perinatal period". The grouping "hemorrhagic and hematological disorders of fetus and newborn" was expanded from 2 categories to 12. Chapter XVII (Congenital malformations, deformations, and chromosomal aberrations) is also noteworthy. Maternal mortality rates and ratios continue to be calculated on the basis of the current definition, which limits this period to 42 days following childbirth. Another new concept is the definition of pregnancy-related death: during pregnancy or within 42 days of the termination of pregnancy.
POSTGRADUATE MEDICAL JOURNAL. 1986; 62(724):93-6.Breastfeeding has been on the decline in the 3rd world for the past 20 years or so. Modernization has been blamed, yet in the industrialized nations of Sweden, Britain, and the US, women play significant roles in the labor force, are active in professional and public life, and in most Western nations the educated women and those from the professional and upper classes are most likely to breastfeed their babies. Regarding milk substitutes, many products unacceptable in the Western market are on sale in developing nations. In the absence of strong governmental controls, consumer pressure, and professional vigilance, bottle feeding is taken lightly with disasterous consequences. 3 main dangers have been identified: those arising from the nonavailability of protective substances of breast milk to the infant; those arising from the contamination of the feed in a highly polluted environment of poverty and ignorance of simple principles of hygiene; and those arising from overdilution of feeds on the account of the costs of the baby foods. Market forces and competition led the manufacturers of baby foods to stake their claims to the markets of the 3rd world, and almost all of them adopted undesirable promotional methods. The ensuing uproar led to an International Code of Ethics being adopted at the 33rd world Health Assembly under the auspices of the World Health Organization. Although the matter should have rested there, some manufacturers developed their own codes and have persuaded governments to adopt alternative codes. The present situation with regard to infant feeding in the 33rd world should be considered in the context of the international developments identified and also in light of several social and demographic processes. At the current rates of growth in population up to 80% of humanity will be living in the 3rd world by the end of the 20th century. The 2nd demographic phenomenon of social and political significance is the unprecedented increase in the growth of the urban population with national health and social services failing to respond adequately to the challenge of this growth. In many developing countries national planners and economists are beginning to look upon human milk as an important national resource, and the need for a network of services to ensure the nutrition and health of pregnant and lactating women is obvious and is recognized internationally. With regard to the question of adequacy of breast milk, there are many gaps in knowledge. Each community needs to be studied separately, and those involved in scientific research in 1 environment should resist the temptation of extrapolating the results to communities and societies with a different set of circumstances.
London, International Planned Parenthood Federation, 1984. 43 p. (IPPF Medical Publications)This booklet, for health care workers in developing countries, reviews the fertility-controlling effects of breastfeeding, its strengths and limitations as an element in family planning, and how to provide modern methods of contraception to lactating women. Breastfeeding currently provides about 30% more protection against pregnancy in developing countries than all of the organized family planning programs. The recent trend toward a falling off in the practice of breastfeeding poses a threat to infant welfare and a danger of increased fertility. Health workers are urged to reach pregnant women in the community with knowledge about the value of breastfeeding versus bottle feeding. Each country must set its own policies concerning contraception for lactating women. It is preferable for lactating women to use nonhormonal methods, but if selected, they should not be used too early. Lowest-dose preparations, especially progestogen-only pills, are preferable. Determination of when to start contraception during lactation should be based on breastfeeding patterns in the community, the age at which supplementary foods are introduced, usual birth spacing intervals, and the mean duration of lactation amenorrhea. If the usual time of resumption of menstruation in a given community is known, a rough guide to the optimal time for starting contraception is returning menstruation minus 2 months.
Bulletin of the World Health Organization. 1982; 60(5):714.The possibility exists of a higher operative complication rate when sterilization is performed immediately following childbirth. This is because the operation is performed at a time of considerable physiological change. To reduce the potential effects of the procedure, many surgeons have adopted the use of a very short incision to gain access to the fallopian tubes. In view of the lack of information on the incidence of complications associated with the use of this technique the World Health Organization (WHO) Special Program of Research, Development, and Research Training in Human Reproduction conducted a prospective, multicentered, multinational study of sterilization by means of a mini-incision carried out within 3 days of childbirth. 1043 women were included in the study, which was conducted in centers in Bangkok, Chandigarh, Havana, Manila, Santiago, Singapore, and Sydney. Data were collected 8 hours, 1 week, and 6 weeks following the operation. Complications were classified as major or minor. Major complications included abandonment of surgery for any reason, excessive bleeding requiring either replacement therapy, additional surgery, or both; damage to any part of the uterus, or any other organ, requiring additional surgery; anesthetic complications that were potentially life threatening; wound problems requiring hospitalization and additional surgery; and pelvic inflammatory disease requiring extension of hospital stay or readmission to hospital. Minor complications included minor change in surgical approach such as enlargement of the incision, loss of 50 ml or more of blood during the procedure, injury to any part of the uterus or other organ, pelvic inflammatory disease treated with antibiotics but without hospitalization, wound problems that did not require additional surgery or hospitalization, and urinary tract infections. Complaints included various symptoms such as headache, abdominal pain, nausea, and vomiting. The overall complication rate was low (4.5%) and there were no cases of thromboembolism. Thus, it appears that sterilization in the immediate postpartum period through a mini-incision adjacent to the umbilicus is a safe procedure associated with no more complications than might be expected with operation at any other time. The complications rates were similar for all modes of anesthesia. The study showed that the operation can be simply and rapidly performed under local anesthesia.
Conclusions and recommendations of the IPPF Central Medical Committee (CMC) and its panel of experts on sterilization.
In: Kleinman, R.L., ed. Male and female sterilization. A report of the meeting of the IPPF Panel of Experts on Sterilization, Bombay, January 11-14, 1973. London, International Planned Parenthood Federation, 1973. p. 8-12The conclusions and recommendations fall into 3 categories, i.e., policy, administrative and technical. Important points in the 1st category include; that sterilization be available and avilable on request, that it be voluntary, and that facilities for reversal procedures be free and avilable. Administrave recommendations include; that no arbitrary hospital stay be assinged to vasectomy patients, that no arbitrary selection criteria concerning previous training or surgical skill be used in accepting personnel for vasectomy patients, that no arbitrary selection criteria concerning previous training or surgical skill be used in accepting personnel for vasectomy training, and that endoscopic techniques should not be done without an anesthetist. Among the technical recommendations were: that postpartum sterilization under local anesthesia by laparotomy be encouraged, as that is the simplest of all female procedures; taht vaginal procedures should only be done with proper operative and anathestic facilities; that division of the uteirne tubes by the Pomeroy technique using 0 chromic catgut should be employed in mass programs of female sterilization; the removal of part of the uterine tube for biopsy and histological examination as a check on the success of the operation should not be done; general anesthesia should never be used for a simple vasectomy unless there are complications; and that tetanus toxoid should not be given to avoid infection.
In: World Health Organization (WHO). World Health Organization expanded programme of research, development, and research training in human reproduction: fourth annual report. Geneva, Switzerland, WHO, November 1975. 33-36. (HRP/75.3)Methods of tubal occlusion being studied for use in developing countries are summarized. A comparative clinic trial will be undertaken in the CCCR network to assess safety of tubal occlusion by surgery when performed postpartum through a vertical miniincision and when performed as an interval procedure by minilaparotomy, laparoscopy, colpotomy, or culdoscopy. 8 chemical tubal occluding agents are being studied at the Central Drug Research Institute in India. Postcoital birth control methods are being investigated including: methods to alter the rate of ovum transport, methods of changihg oviduct motility (including the effect of steroids, catecholamine stimulating and blocking agents, prostaglandins, ergot derivatives, and oxytocics), and methods affecting ovum survival. A WHO Symposium on "Ovum Transport and Fertility Regulation" was held in June 1975 in San Antonio, Texas, to present the work of these various scientists.
Studies in Family Planning. 1972; 3(7):151-156.In Thailand the family planning program is integrated into health services. During 1971 there were 404,187 new acceptors, the majority of which chose the pill since they are prescribed by midwives and are available in more than 3500 centers. The number of pill acceptors increased from approximately 8800 per month to more than 30,000 after auxiliary midwives were officially authorized to prescribe oral contraceptives. In 1972 a pilot program was started to train paramedical personnel to insert IUDs. In 1971 12-month continuation rates were 75% for the IUD (with the majority of women expelling them having reinsertions), 65% for the pill, with more than 20,000 sterilizations. A major effort will be made during 1972 to introduce vasectomy more widely. More than 80% of acceptors are from rural areas, with 90% having less than 4 years of education. Postpartum acceptors accounted for 16% of the national program. Since 85% of all deliveries occur at home, the postpartum concept should be adapted to these women. In a 1970 followup survey of 2597 acceptors in the 3 largest cities, among IUD users, expulsions were negatively correlated and removals positively correlated with age; pregnancies were 3%. Pills were more widely accepted than IUDs in all age groups, and younger women definitely preferred them. The source of family planning information was: husband, 47%; health personnel, 38%. It is estimated that 144,000 couple years of protection were provided in 1971, and 393,000 in 1972 -- 3% and 8% respectively of married women of reproductive age. Cost of the program is estimated to be US$.08 per capita or US$7.00 or $8.00 per acceptor. The greatest problem has been lack of effective supervision at the field level. The usefulness of family planning field workers is being studied.
Economic and Political Weekly. 1983 Dec 10; 18(50):2099.This article summarizes World Health Organization (WHO) guidelines on breastfeeding issued in 1982 and discusses their policy implications for India. The WHO document notes that early use of combined oral contraceptives (OCs) after childbirth may both decrease breast milk production and cause women to abandon the pill, denying them the contraceptive protection they would have had if lactation had proceeded uninterrupted. The WHO paper further notes the possible adverse effects on infants exposed to synthetic sex steroids secreted in the breast milk of users of hormonal contraception. This suggests that family planning programs should consider the special needs of breastfeeding women in determining the contraceptive methods to be promoted. Grassroots family planning wokers are in special need of intensive instruction in this area. WHO additionally calls for social and health support systems which encourage breastfeeding and urges that such initiatives form an integral component of family planning programs. WHO's emphasis on breastfeeding as a means of averting births rather than strictly as a means of improving child health is expected to attract the interest of policymakers.