WHO Statement on Caesarean Section Rates

World Health OrganizationWHO, UNDP, UNFPA,World Bank Special Programme Res, UNICEF,Dev & Res Training Human Reprod,Dept Repro, CH-1211 Geneva, SwitzerlandUniv Fed Sao Paulo, Sao Paulo Sch Med, Brazilian Cochrane Ctr, Sao Paulo, BrazilUniv Fed Sao Paulo, Sao Paulo Sch Med, Dept Obstet, Sao Paulo, BrazilShanghai Jiao Tong Univ, Sch Med, Shanghai Key Lab Childrens Environm Hlth, Minist Educ,Xinhua Hosp, Shanghai 200030, Peoples R ChinaUniv Fed Sao Paulo, Sao Paulo Sch Med, Brazilian Cochrane Ctr, Sao Paulo, BrazilUniv Fed Sao Paulo, Sao Paulo Sch Med, Dept Obstet, Sao Paulo, BrazilWHO: 001Web of Scienc

WHO Statement on Caesarean Section Rates

World Health OrganizationWHO, UNDP, UNFPA,World Bank Special Programme Res, UNICEF,Dev & Res Training Human Reprod,Dept Repro, CH-1211 Geneva, SwitzerlandUniv Fed Sao Paulo, Sao Paulo Sch Med, Brazilian Cochrane Ctr, Sao Paulo, BrazilUniv Fed Sao Paulo, Sao Paulo Sch Med, Dept Obstet, Sao Paulo, BrazilShanghai Jiao Tong Univ, Sch Med, Shanghai Key Lab Childrens Environm Hlth, Minist Educ,Xinhua Hosp, Shanghai 200030, Peoples R ChinaUniv Fed Sao Paulo, Sao Paulo Sch Med, Brazilian Cochrane Ctr, Sao Paulo, BrazilUniv Fed Sao Paulo, Sao Paulo Sch Med, Dept Obstet, Sao Paulo, BrazilWHO: 001Web of Scienc

Developing and applying a 'living guidelines' approach to WHO recommendations on maternal and perinatal health

How should the WHO most efficiently keep its global recommendations up to date? In this article we describe how WHO developed and applied a 'living guidelines' approach to its maternal and perinatal health (MPH) recommendations, based on a systematic and continuous process of prioritisation and updating. Using this approach, 25 new or updated WHO MPH recommendations have been published in 2017-2018. The new approach helps WHO ensure its guidance is responsive to emerging evidence and remains up to date for end users

Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis

BACKGROUND: What constitutes respectful maternity care (RMC) operationally in research and programme implementation is often variable. OBJECTIVES: To develop a conceptualisation of RMC. SEARCH STRATEGY: Key databases, including PubMed, CINAHL, EMBASE, Global Health Library, grey literature, and reference lists of relevant studies. SELECTION CRITERIA: Primary qualitative studies focusing on care occurring during labour, childbirth, and/or immediately postpartum in health facilities, without any restrictions on locations or publication date. DATA COLLECTION AND ANALYSIS: A combined inductive and deductive approach was used to synthesise the data; the GRADE CERQual approach was used to assess the level of confidence in review findings. MAIN RESULTS: Sixty-seven studies from 32 countries met our inclusion criteria. Twelve domains of RMC were synthesised: being free from harm and mistreatment; maintaining privacy and confidentiality; preserving women's dignity; prospective provision of information and seeking of informed consent; ensuring continuous access to family and community support; enhancing quality of physical environment and resources; providing equitable maternity care; engaging with effective communication; respecting women's choices that strengthen their capabilities to give birth; availability of competent and motivated human resources; provision of efficient and effective care; and continuity of care. Globally, women's perspectives of what constitutes RMC are quite consistent. CONCLUSIONS: This review presents an evidence-based typology of RMC in health facilities globally, and demonstrates that the concept is broader than a reduction of disrespectful care or mistreatment of women during childbirth. Innovative approaches should be developed and tested to integrate RMC as a routine component of quality maternal and newborn care programmes. TWEETABLE ABSTRACT: Understanding respectful maternity care - synthesis of evidence from 67 qualitative studies

The WHO application of ICD-10 to deaths during the perinatal period (ICD-PM):results from pilot database testing in South Africa and United Kingdom

Objective To apply the World Health Organization (WHO) Application of the International Classification of Diseases, tenth revision (ICD-10) to deaths during the perinatal period: ICD-Perinatal Mortality (ICD-PM) to existing perinatal death databases. Design Retrospective application of ICD-PM. Setting South Africa, UK. Population Perinatal death databases. Methods Deaths were grouped according to timing of death and then by the ICD-PM cause of death. The main maternal condition at the time of perinatal death was assigned to each case. Main outcome measures Causes of perinatal mortality, associated maternal conditions. Results In South Africa 344/689 (50%) deaths occurred antepartum, 11% (n = 74) intrapartum and 39% (n = 271) in the early neonatal period. In the UK 4377/9067 (48.3%) deaths occurred antepartum, with 457 (5%) intrapartum and 4233 (46.7%) in the neonatal period. Antepartum deaths were due to unspecified causes (59%), chromosomal abnormalities (21%) or problems related to fetal growth (14%). Intrapartum deaths followed acute intrapartum events (69%); neonatal deaths followed consequences of low birthweight/prematurity (31%), chromosomal abnormalities (26%), or unspecified causes in healthy mothers (25%). Mothers were often healthy; 53%, 38% and 45% in the antepartum, intrapartum and neonatal death groups, respectively. Where there was a maternal condition, it was most often maternal medical conditions, and complications of placenta, cord and membranes. Conclusions The ICD-PM can be a globally applicable perinatal death classification system that emphasises the need for a focus on the mother-baby dyad as we move beyond 2015