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  1. 1

    Essential elements of obstetric care at first referral level.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 1991. vii, 72 p.

    Members of WHO's Technical Working Group on Essential Obstetric Functions at First Referral Level have prepared a book geared towards district, provincial, regional, national, and international decision makers, particularly those in developing countries, whose areas of expertise include planning, financing, and organization and management of obstetric services. The guidelines should allow them to improve referral services' standards at the district level. They should also help them decide how far and by what means they may possibly expand some of these services to more peripheral levels, e.g., renovating facilities and improving staff. When developing these guidelines, WHO took in consideration that many countries confront serious economic obstacles. The book's introduction briefly discusses maternal morbidity and mortality in developing countries and maternity care in district health systems. The second chapter, which makes up the bulk of the book, addresses primary components of obstetric care related to causes of maternal death. This chapter's section on surgical obstetrics examines cesarean section and repair of high vaginal and cervical tears among others. Its other sections include anesthesia, medical treatment, blood replacement, manual procedures and monitoring labor, family planning support, management of women at high risk, and neonatal special care. The third section provides guidelines for implementation of these services, including cost and financial considerations. It emphasizes the need at the first referral level to have the least trained personnel perform as many health care procedures as possible, as long as they can do so safely and effectively. Other implementation issues are facilities, equipment, supplies, drugs, supervision, evaluation, and research. Annexes list the required surgical and delivery equipment, materials for side ward laboratory tests and blood transfusions, essential drugs, and maternity center facilities and equipment.
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  2. 2

    Maternal mortality ratios and rates: a tabulation of available information. 3d ed.

    World Health Organization [WHO]. Division of Family Health. Maternal Health and Safe Motherhood Programme

    [Unpublished] [1991]. 100 p. (WHO/MCH/MSM/91.6)

    The Maternal Health and Safe Motherhood Programme under WHO's Division of Family Health has compiled maternal mortality data in its 3rd edition of Maternal Mortality Ratios and Rates. The report contains data up to 1991. These data come from almost all WHO member countries. 1988 estimates reveal that 509,000 women die each year from causes related to pregnancy and childbirth. Most die from preventable causes such as aseptic abortions and lack of adequate health care. 4000 of these maternal deaths occur in developed countries. Thus developing countries, where 87% of the world's births occur, experience 99% of maternal deaths. In fact, the lifetime risk of death from causes related to pregnancy and childbirth in developing countries is 1:57 compared to 1:1825 in developed countries. Women in countries of western Africa have the greatest risk (1:18) and those in North America the smallest risk (1:4006). Even though the maternal mortality ratio for developing countries fell from 450-520 per 100,000 live births between 1983-1988, it increased in western African countries (700-760). This report consists mainly of tables of maternal mortality estimates for each country and in some cases certain areas of each country, for the world and various regions and subregions, and changes in maternal mortality since 1983 for the world and various regions and subregions. The world comparison table includes live births, maternal deaths, maternal mortality ratios and rates, lifetime risk, and total fertility. Country tables list year, data sources, maternal mortality ratio, indication if abortion deaths were included or not, and reference.
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  3. 3

    [Blood pressure complications of pregnancy: through collaborative studies, WHO seeks solutions] Les troubles tensionnels de la grossesse: par des etudes collectives, l'OMS cherche des solutions.

    MATERNITE SANS RISQUES. 1991 Jul-Oct; (6):8.

    Eclampsia, an obstetrical emergency described in medical texts going back over a century, is characterized by convulsion, loss of consciousness, and high risk of death in the absence of careful medical treatment. Many cases can be prevented if the signs are recognized and treated in time. High blood pressure often giving rise to severe headaches, proteinuria, and edema causing abnormal swelling of the arms, legs, and face are precursors. The possibility of preventing eclampsia led the World Health Organization to undertake a collaborative study of the prevalence, causes, and effects of hypertensive disorders of pregnancy in different parts of the world. The principal investigators of 7 countries who met in Singapore to compare their findings noted strikingly different rates of eclampsia and preeclampsia in the 4 Asian countries represented. Edema was found to be a useful indicator of increased risk where health resources are scarce and the incidence of hypertension and edema are low. A study of maternal mortality in Jamaica around this time found that about 1/3 of deaths from direct obstetrical causes resulted from hypertensive disorders, most often eclampsia. The Jamaican researchers proposed a research project using techniques developed during the collaborative study. Data on more than 10,000 pregnant women allowed detailed study of hypertension, preeclampsia, and eclampsia. Among the women, .72% had had a crisis of eclampsia and 10.4% had hypertension, accompanied by proteinuria in about half the cases. Primigestes, women over 30, and those gaining more than normal amounts of weight during pregnancy were identified as at increased risk. The best indicator of risk was the coexistence of at least 2 out of 3 factors: edema, diastolic pressure of 80 mmHg or over, and proteinuria. The findings caused Jamaica to launch 2 programs, the 1st to screen pregnant women for risk factors for eclampsia and provide special care, and the 2nd to provide small doses of aspirin to half of pregnant women and a placebo to the other half to verify whether small doses of aspirin are an effective means of preventing eclampsia. The World Health Organization is supporting a controlled study of the efficacy of calcium tablets in preventing eclampsia in Peru and is considering a study comparing 2 different regimes for treating eclampsia in Argentina.
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