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Recommendations for augmentation of labour. Highlights and key messages from World Health Organization's 2014 global recommendations.
[Geneva, Switzerland], WHO, 2015 Apr.  p. (WHO/RHR/15.05; USAID Cooperative Agreement No. AID-OAA-A-14-00028.)This evidence brief provides highlights and key messages from the World Health Organization’s 2014 Global Recommendations on the Augmentation of Labor. The goal of the brief is to summarize guidelines for effective interventions for safe augmentation to accelerate their dissemination and use. Additionally, policy and programme actions to incorporate the new guidelines are outlined alongside the recommendations. This brief is intended for policy-makers, programme managers, educators and providers who care for pregnant woman.
Lancet. 2007 May 26; 369(9575):1789-1790.Although pelvic organ prolapse is a significant problem in affluent countries, the situation in developing countries is far worse. This is mainly a result of high fertility with early marriage and childbearing, many vaginal deliveries, and in certain countries such as Nepal, frequent heavy lifting. In Nepal, fertility until recently was very high and most deliveries take place at home, with only 14% in a health facility and less than 3% by caesarean section. In developing countries, the extent and effects of morbidity associated with pelvic organ prolapse are seldom acknowledged, because of patients' embarrassment. However, studies in Nepal, supported by the United Nations Population Fund (UNFPA), have begun to identify the suffering of women with this disorder. Findings indicate that 10% of women have pelvic organ prolapse, of whom about half require operative management (30.9% with stage II, 12.6% with stage III, and 1.4% with stage IV or procidentia). Women report difficulty in sitting (82%), walking (79%), and lifting (89%), all of which affect their acceptance as full family and community members. The social consequences of prolapse are substantial, and include physical and emotional isolation, abandonment, divorce, ridicule, low self esteem, abuse, lack of economic support, and domestic violence. In Nepal, UNFPA is supporting efforts to identify women with pelvic organ prolapse through reproductive health camps and to contract gynecologists to treat these women at district hospitals. We suggest that more attention should be given to acknowledging the profound consequences of uterine organ prolapse and establishing programmes in developing countries to prevent and manage this frequently severely debilitating condition. (full text)
Geneva, World Health Organization, 1966. (Technical Report Series NO. 332).The value and possible hazards of IUDs are discussed. Grafenberg developed a metal ring IUD in 1928. There was initial enthusiasm about the device, but it became discredited and interest was not revived in the method until 1959. Today, various shapes, sizes, and materials are employed in making IUD'S. No single cause or mechanism of action of an IUD has so far come to light. In sub-human primates the IUD causes accelerated passage of ova through the tube and the rest of the reproductive tract appears to be the major, but not necessarily the only, mechanism, of action. In ruminants, the contraceptive action of the IUD is exerted, at least in part, at the ovarian level. In rats, mice, rabbits, and ferrets, the main effect of the IUD is suppression of the implantation. It is concluded that the action of the IUDs in the human species is exerted before the stage of implantation. The most effective devices are associated with an incidence of 1.8 to 2.9 pregnancies per 100 insertions during the first year of use. The frequency of spontaneous expulsion ranges from about 5% to over 20% depending on the type of device. About one half of all expulsions occur in the first 3 months and comparatively few after the first year. The incidence of removal for medical reasons ranges from approximately 10% to 25% of first insertions during the first year. The method can be used successfully by almost 3 out of every 4 women who adopt it. Side effect and complications include bleeding and pain and less frequently pelvic inflammatory disease and perforation. The only absolute contraindications to the use of IUDs are: (1) active pelvic inflammatory disease, and (2) pregnancy, proven or suspected. Research needs are noted.
The WHO Collaborative Study of Neoplasia and Steroid Contraceptives: the influence of combined oral contraceptives on risk of neoplasms in developing and developed countries.
CONTRACEPTION. 1991 Jun; 43(6):695-710.A hospital-based case-control study was conducted in 8 developing and 3 developed countries to determine whether use of combined oral contraceptives (OCs) alters risks of various cancers. An observed trend of increasing risk of invasive cervical cancer with duration of use may not represent a causal relationship and is the subject of further study. Decreased risks of ovarian and endometrial carcinomas in users likely indicate a protective effect of OCs, the degree of which was similar in developing and developed countries. A small increase in risk of breast cancer in recent and current users was found to be somewhat greater in developing countries. Both causal and noncausal interpretations of this finding have been offered. No associations were found between OCs and in situ cervical, hepatocellular, cholangio, or gallbladder carcinomas, or uterine sarcomas. However, the ability of this study to detect alterations in risks for these neoplasms in longterm users was low. (author's)
Healthright. 1985 Aug; 4(4):9-12.The pattern of reproductive activity displayed by early hunter-gatherer ancestors, before the dawn of civilization, must have been vastly different from today's pattern. In the absence of contraception such women would have spent the greater part of their reproductive lives either pregnant or in lactational amenorrhea. In developing these ideas further it was estimated that a hunter-gatherer woman would have spent about 15 years in lactational amenorrhea, whereas just under 4 years would have been occupied by her 5 pregnancies, and she would only have had about 4 years of menstrual cycles. The total number of menstrual cycles she would experience in her entire life would be no more than about 50. This is in marked contrast to the situation today in a typical Western woman using contraceptives and experiencing menarche at 13 and the menopause at 50. Allowing her 2 years' respite from cycles during her 2 pregnancies, each followed by only a token period of breastfeeding, this leaves 35 years during which she would experience about 420 menstrual cycles. The conclusion is that an excessive number of menstrual cycles is an iatrogenic disorder of communities practicing any form of contraception. Thus, it is important to note that even the condom or vasectomy have important repercussions on the female's reproductive cycle. Since 99.9% of human existence has been spent living a nomadic hunter-gatherer life, this high frequency of menstrual cycles is a new experience, one that humans may be genetically ill-adapted to cope with. In fact, there are a number of "diseases of nulliparity" whose incidence is markedly increased in women with few or no children and who are therefore experiencing an increased number of menstrual cycles. These diseases include carcinoma of the breast, endometrium and ovaries, and endometriosis. As part of the effort to develop contraceptives that promote a healthy state of fertility, it is necessary to ask the question, "is a period really necessary?" To learn if women women accept a contraceptive method that reduced the frequency of menstruation, a clinical trial of an oral contraceptive was conducted. The OC was administered in such a way as to produce a withdrawal bleed only once every 3 months. This was termed the tricycle pill regimen. 196 women attending a family planning clinic in Edinburgh, Scotland, volunteered to participate, although 89 of them subsequently withdrew from the trial for a variety of reasons before it was completed at the end of a year. Overall, 82% of the women positvely welcomed the reduction in the number of periods; 91% of the women who completed the trial even refused to revert to a standard monthly OC regimen thereafter. The findings were in complete contrast to the results of a World Health Organization survey of patterns and perceptions of menstruation. But the WHO sample was highly biased in favor of women having regular menstrual cycles, and hence quite unrepresentative of the population as a whole. In sum, even the most pessimistic estimate of the WHO's menstruation survey shows that a proportion of women in every country investigated were prepared to accept amenorhea as a by-product of contraception. Reversible amenorrhea might become an increasingly popular form of contraception, and it might also confer significant health benefits.
In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagen, Denmark, Scriptor, 1977. p. 283-321This review of low-dose gestagen contraception emphasizes the variety of findings from different studies. For example, studies of chlormadinone acetate have found pregnancy rates of 1.1-12/100 woman-years. Results of trials of megestrol acetate suggested that a 500-mcg dose level yielded unacceptable pregnancy rates. No significant difference between various doses of norgestrel which have been studied were found (e.g., 50 and 75 mcg daily of dl-norgestrel or 30 mcg daily of the d-isomer). Pregnancy rate reported for most trials with this gestagen and also norethisterone and quingestanol were within an acceptable range. With 1 exception, pregnancy rates reported in trials of lynestrenol were remarkable low. Cumulative results of trials with various gestagens show Pearl Index rates between 2 and 3, except for lynestrenol. Dose level was the critical variable; i.e., it must be sufficiently high to exert antifertility action and low enough to avoid a high incidence of irregular bleeding. Apart from menstrual irregularities, other side effects from the minipill seem minor and in general less severe than those encountered with combined oral contraceptives.
[Unpublished] . 9 p.Several questions raised by the US Food and Drug Administration (FDA) Public Board of Inquiry on injectable contraceptives are answered by Susan Holck, Ralph Heywood, and Ian Fraser of the World Health Organization (WHO). As to whether human data submitted by Upjohn can refute the risk of human cancer suggested by animal experimentation data the following findings are noted: 1) the preliminary findings of WHO studies do not appear to implicate Depo-Provera as a cause of either in situ or invasive cervical carcinoma but results of further analyses of the existing data will need to be considered before a final conclusion is reached; 2) data from 109 cases of breast cancer and 1812 controls in Thailand do not show that Depo-Provera may increase the risk of breast cancer in women who use this product as a contraceptive; and 3) the numbers of cases of cancer of the uterine corpus, ovary, and hepatobiliary organs are not substantial enough to suggest a public health problem. The 2nd question was whether in the event of contraceptive failure, use of Depo-Provera may increase the risk of teratogenic effects to a greater extent than would other systemic contraceptives. In a clinical trial of 1587 subjects using Depo-Provera the cumulative life table analysis pregnancy rate was 0.1/100 women at 12 months and 0.4/100 women at 24 months, comparing with rates 1.0-3.6/100 women observed with the most commonly used oral contraceptives in another WHO study undertaken in similar populations; contraceptive failures should be relatively uncommon with Depo-Provera use. A WHO scientific group in 1981 noted that there is no evidence that use of Depo-Provera will increase the risk of teratogenic effects to a greater extent than other hormonal contraceptives. 3 limitations which have been encountered in developing research strategies which would provide significant results are: 1) contraceptive failure with Depo-Provera use is rare, so that just a few pregnant women should be exposed to the drug; 2) Depo-Provera is widely used among only a few populations; and 3) the anomalies to be studied are rare.