Best practice & research. Clinical obstetrics & gynaecology
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Best Pract Res Clin Obstet Gynaecol · Oct 2016
ReviewAccountability for improving maternal and newborn health.
In 2010, the United Nations (UN) launched the Global Strategy for Women's and Children's Health to accelerate progress on maternal and child health. A UN Commission on Information and Accountability, established to ensure oversight and accountability on women's and children's health, outlined a framework with three processes: monitor, review, and act. This paper assesses progress on these processes. ⋯ Strategies are underway to improve accountability for severe maternal morbidity and perinatal mortality. The post-2015 agenda adds greater focus on reducing inequalities, increasing availability of quality, disaggregated data, and accountability for human rights. This agenda requires engagement with communities and health providers - the foundation of accountability for women's and children's health.
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Prevention of deaths from obstetric haemorrhage requires effective health systems including family planning, commodities, personnel, infrastructure and ultimately universal access to comprehensive obstetric care for women giving birth. The main causes of death associated with antepartum haemorrhage are placental abruption, placenta praevia and uterine rupture. Preventive measures include preconceptual folate supplementation, management of hypertensive disorders, early diagnosis of placenta praevia and use of uterine stimulants cautiously, particularly misoprostol. ⋯ Emergency temporizing measures include application of the non-pneumatic anti-shock garment, and at laparotomy, aortic compression and uterine tourniquet application. The effectiveness of treatment methods and the optimal dosage of misoprostol are research priorities. Interesting new approaches include transvaginal uterine artery clamping and suction uterine tamponade.