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 · Jun 2015
Randomized Controlled Trial Comparative StudyDouble-blind randomized controlled trial comparing misoprostol and oxytocin for management of the third stage of labor in a Nigerian hospital.
To compare the efficacy of oral misoprostol with that of oxytocin for active management of the third stage of labor (AMTSL). ⋯ The efficacy of oral misoprostol was similar to that of intramuscular oxytocin. Adverse effects associated with misoprostol were transient and self-limiting. Thus, oral misoprostol is efficacious and a good alternative to oxytocin for AMTSL. Pan African Clinical Trials Registry:PACTR201407000825227.
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Int J Gynaecol Obstet · Jun 2015
Implementation of the Standards-Based Management and Recognition approach to quality improvement in maternal, newborn, and child health programs in low-resource countries.
The Standards-Based Management and Recognition (SBM-R; Jhpiego, Baltimore, MD, USA) approach to quality improvement was developed by Jhpiego to respond to common challenges faced by health systems in low-resource settings, including poor pre-service education, lack of resources for conventional supervisory models, and weak health information systems. Since its introduction in Brazil in 1997, SBM-R has been implemented in approximately 30 countries and continues expanding to new places and service delivery areas. The present article: (1) describes key steps in the SBM-R methodology focusing on provider performance assessment using evidence-based standards; and (2) presents examples of improvements in provider performance in maternal, newborn, and child health care following SBM-R implementation derived from routine program data, quasi-experimental evaluations, and in-depth case studies. SBM-R incorporates evidence-based methods that are known to have positive effects on healthcare quality, including audit and feedback, educational outreach visits, and checklist usage; however, further rigorous research is needed to document the population-level impacts of the SBM-R approach.
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Int J Gynaecol Obstet · Jun 2015
Medical, legal, and ethical challenges associated with pregnancy and catastrophic brain injury.
In late 2013, two women from North America gained attention after sustaining catastrophic brain injuries while pregnant. After Marlise Muñoz--who was at 14 weeks of pregnancy when she developed a pulmonary embolism--was pronounced brain dead, hospital officials initially refused to withdraw support, citing a Texas state law requiring them to maintain life-sustaining treatment for a pregnant patient to help to save the fetus. ⋯ The Muñoz and Benson cases offer an opportunity to explore the medical, legal, and ethical issues surrounding catastrophic brain injury in pregnant women. It is hoped that the present article will enable clinicians to better appreciate the history and present state of issues involving advance directives for pregnant women, maternal versus fetal interests, and the impact of fetal viability on medical decision making, as well as offer a practical assessment of the various US state laws concerning the rare, yet catastrophic event of brain injury in a pregnant woman.
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Int J Gynaecol Obstet · Jun 2015
Editorial Historical ArticleAnnouncing the winner of the John J. Sciarra IJGO Prize Paper Award for 2014.
The editors of the International Journal of Gynecology and Obstetrics (IJGO) are pleased to announce the winner of the prize paper award for the best clinical research paper from a low- or middle-income country published in the IJGO during 2014. The winning paper is: Dan K. Kaye, Othman Kakaire, Annettee Nakimuli, Scovia N. ⋯ Survivors' understanding of vulnerability and resilience to maternal near-miss obstetric events in Uganda. Int J Gynecol Obstet 2014;127(3):265–8. It was published in the December 2014 issue of the IJGO.
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Int J Gynaecol Obstet · Jun 2015
Incidence of eclampsia with HELLP syndrome and associated mortality in Latin America.
To describe the maternal outcome among women with eclampsia with and without HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). ⋯ Eclampsia with HELLP syndrome is a dangerous complication associated with pregnancy. Low platelet count secondary to HELLP syndrome and severe systolic hypertension were independently associated with maternal mortality from eclampsia.