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 2009
ReviewReducing intrapartum-related deaths and disability: can the health system deliver?
Each year 1.02 million intrapartum stillbirths and 904,000 intrapartum-related neonatal deaths (formerly called "birth asphyxia") occur, closely linked to 536,000 maternal deaths, an estimated 42% of which are intrapartum-related. ⋯ Even in high-performance settings, there is scope to improve intrapartum care and especially reduce impairment and disability. Addressing missed opportunities for births already occurring in facilities could avert 36% of intrapartum-related deaths. Improved quality of care through drills and audit are promising strategies. However, the majority of deaths occur in poorly performing health systems requiring urgent strategic planning and investment to scale up effective care at birth, neonatal resuscitation, and community mobilization as well as to develop, adapt, and introduce tools, technologies, and task shifting to reach the poorest.
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Int J Gynaecol Obstet · Sep 2009
Randomized Controlled TrialAdverse effects of combined spinal-epidural versus traditional epidural analgesia during labor.
To compare two neuraxial block techniques during labor for maternal and fetal effects. ⋯ There were no differences in the rate of PD or other adverse outcomes. Hypotension occurred more frequently with CSE during labor at term. The study supports both EPI and CSE during labor as safe and effective techniques for neuraxial analgesia.
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Int J Gynaecol Obstet · Sep 2009
Randomized Controlled TrialEffect of intra-abdominal instillation of lidocaine during minor laparoscopic procedures.
To assess the effect of intraperitoneal instillation of lidocaine on postoperative pain after minor gynecological laparoscopic surgery. ⋯ Intraperitoneal instillation of lidocaine was effective in reducing postoperative pain after minor gynecological laparoscopic procedures.
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The brain drain of health workers occurs mostly from low- and low/middle-income countries to resource-rich countries and from rural to urban areas. Shortage and uneven distribution of healthcare workers aggravated by the brain drain from Africa, Asia, and Pacific countries has contributed to impaired reproductive and sexual health services and the high rate of maternal and newborn mortality and morbidity in these counties. ⋯ A code of practice on international recruitment of health personnel is needed. Improving the health workforce database, wages, health resources and working conditions, task shifting, pay-back from recipient countries and migrant health professionals, securing additional investment in the health workforce, and the development of locally relevant medical training and research are useful measures to combat this problem.
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Worldwide, one woman dies every minute as a result of being pregnant. This statistic highlights the denial of women's rights to safe motherhood in many parts of the world, particularly in low-resource countries where 98% all maternal deaths occur. The majority of pregnant women die because they deliver unattended by a properly trained birth professional. ⋯ Philanthropy is diverted by other competing needs, such as HIV prevention and treatment, or provision of urgent food supplies. Equity is denied because women's health is too often set as a low priority. Utilitarianism advocates that safe motherhood is an investment of societal shared interest.