International journal of gynaecology and obstetrics : the official organ of the International Federation of Gynaecology and Obstetrics
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Int J Gynaecol Obstet · Oct 2012
Applying human rights to improve access to reproductive health services.
Universal access to reproductive health is a target of Millennium Development Goal (MDG) 5B, and along with MDG 5A to reduce maternal mortality by three-quarters, progress is currently too slow for most countries to achieve these targets by 2015. Critical to success are increased and sustainable numbers of skilled healthcare workers and financing of essential medicines by governments, who have made political commitments in United Nations forums to renew their efforts to reduce maternal mortality. ⋯ Health advocates are using human rights mechanisms to ensure governments honor their legal commitments to ensure access to services essential for reproductive health. Maternal mortality is recognized as a human rights violation by the United Nations and constitutional and human rights are being used, and could be used more effectively, to improve maternity services and to ensure access to drugs essential for reproductive health.
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Transfusion therapy in postpartum hemorrhage (PPH) traditionally has been modeled after precedents set in the Vietnam and Korean wars. However, data from recent military combat casualties suggest a different transfusion strategy. Transfusion of packed red blood cells, fresh frozen plasma, and platelets in a ratio of 1:1:1 improves dilutional coagulopathy and survival. ⋯ Observational data suggest that the use of recombinant factor VIIa should be limited to bleeding that has not responded to an optimal transfusion strategy. Point-of-care testing using thromboelastography is helpful in guiding the selection of blood products to be transfused. Additionally, massive transfusion protocols can decrease the overall number of products transfused and improve outcomes.
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Int J Gynaecol Obstet · Oct 2012
Professional leadership in obstetrics and gynecology and its contribution to Millennium Development Goal 5.
National professional associations of obstetrics and gynecology characteristically begin as learned societies holding regular conferences for the presentation and discussion of new research results, and progress to regulating the activities of their members in the public interest (e.g. admission examinations, setting standards). However, they can offer much more to their nation's health by contributing directly to improvements in health care and influencing governmental decisions in favor of the health of women and babies. The International Federation of Gynecology and Obstetrics (FIGO), through the Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) initiative, is developing the capacity of national professional associations in Africa and Asia, so that they can contribute to improving clinical practice and influence national health policy toward achieving Millennium Development Goal 5.
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The effect of HIV infection on maternal mortality is best documented in South Africa, where HIV prevalence rates in pregnancy are among the highest in the world. Since 1998, detailed data on maternal deaths in South Africa have been available in the form of Confidential Enquiries reports. The latest report (Saving Mothers Report, 2005-2007) suggests that the maternal mortality ratio in HIV-infected women was about 10 times higher than in uninfected women. ⋯ The most common causes of maternal death among HIV-positive women were nonpregnancy-related infections, including AIDS, pneumonia, tuberculosis, and meningitis. HIV-infected pregnant women were also at greater risk of dying from pregnancy-related sepsis and complications of abortion than their uninfected counterparts. Reduction of HIV-related maternal deaths must be seen as a worldwide priority in maternal health care.