Who Recommendations For Prevention And Treatment Of Maternal Peripartum Infections

The goal of the present guideline is to consolidate guidance for effective interventions that are needed to reduce the global burden of maternal infections and its complications around the time of childbirth. This forms part of WHO's efforts towards improving the quality of care for leading causes of maternal death especially those clustered around the time of childbirth in the post-MDG era. Specifically it presents evidence-based recommendations on interventions for preventing and treating genital tract infections during labour childbirth or puerperium with the aim of improving outcomes for both mothers and newborns. The primary audience for this guideline is health professionals who are responsible for developing national and local health protocols and policies as well as managers of maternal and child health programmes and policy-makers in all settings. The guideline will also be useful to those directly providing care to pregnant women including obstetricians midwives nurses and general practitioners. The information in this guideline will be useful for developing job aids and tools for both pre- and inservice training of health workers to enhance their delivery of care to prevent and treat maternal peripartum infections.

Optimizing outcomes for women in labor at the global level requires evidence-based guidance of health workers to improve care through appropriate patient selection and use of effective interventions. In this regard, the World Health Organization (WHO) published recommendations for induction of labor in 2011. The goal of the present guideline is to consolidate the guidance for effective interventions that are needed to reduce the global burden of prolonged labor and its consequences. The primary target audience includes health professionals responsible for developing national and local health protocols and policies, as well as obstetricians, midwives, nurses, general medical practitioners, managers of maternal and child health programs, and public health policy-makers in all settings.

Hypertensive disorders of pregnancy are an important cause of severe morbidity, long-term disability and death among both pregnant women and their babies, and account for approximately 14% of all maternal deaths worldwide. Improving care for women around the time of childbirth is a necessary step towards achievement of the health targets of the Sustainable Development Goals (SDGs). Efforts to prevent and reduce morbidity and mortality during pregnancy and childbirth could also help address the profound inequities in maternal and perinatal health globally. To achieve these goals, healthcare providers, health managers, policy-makers and other stakeholders need up-to-date and evidence-based recommendations to inform clinical policies and practices. In 2019, the Executive Guideline Steering Group (GSG) on WHO maternal and perinatal health recommendations prioritized issuing new WHO recommendations on antihypertensive drugs for non-severe (mild to moderate) hypertension during pregnancy in response to new important evidence on this intervention. For this guideline, non-severe hypertension and mild to moderate hypertension is used interchangeably, defined as diastolic blood pressure of 90–109 mmHg.

The primary goal of this guideline is to provide a foundation for the implementation of interventions shown to have been effective in reducing the burden of PPH (postpartum haemorrhage). Health professionals responsible for developing national and local health policies constitute the main target audience of this document. Obstetricians, midwives, general medical practitioners, health care managers and public health policy-makers, particularly in under-resourced settings are also targeted. This document establishes general principles of PPH care and it is intended to inform the development of clinical protocols and health policies related to PPH.

Provides effective diagnosis and management of infectious diseases in pregnant women in a single comprehensive available resource for busy clinicians.

Addresses the challenges of managing critically ill obstetric patients, with chapters authored by intensivists/anesthesiologists and obstetricians/maternal-fetal medicine specialists.

“Operative vaginal birth” is the term used to describe delivery of the fetal head assisted by either vacuum extractor or forceps. The Guideline Development Group noted that the available evidence, from highincome countries, strongly supports the use of a single dose of intravenous amoxicillin (1 g) and clavulanic acid (200 mg) administered as soon as possible after birth and no more than 6 hours after birth. The effects of other antibiotics and routes of administration for this indication are unknown. The Guideline Development Group recognized that intravenous amoxicillin and clavulanic acid may not be readily available or feasible to use in resource-limited settings and suggested that where this combination is not available, providers should consider the use of an appropriate class of antibiotics with similar spectrum of activity, based on local antimicrobial resistance patterns, safety profile (including allergies), the clinician’s experience with that class of antibiotics, availability and cost. The risk of postpartum infections and side-effects of antibiotics should be discussed with all women undergoing operative vaginal birth at the earliest time possible before or after birth. This recommendation was based on agreement by the Guideline Development Group that the improved health outcomes for women were clinically significant and outweighed the potential effects on emerging antimicrobial resistance.