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Intrapartum Electronic Fetal Heart Rate Monitoring

The purpose of this document is to: 1) review nomenclature for fetal heart rate assessment, 2) review the data on the efficacy of electronic fetal monitoring (EFM), and 3) delineate the strengths and shortcomings of EFM. It also compares international three-tier systems for fetal heart rate tracing, including the National Institute of Child Health and Human Development (NICHD), Society of Obstetricians and Gynecologists of Canada (SOGC) and the Royal College of Obstetricians and Gynecologists (RCOG, United Kingdom). The collaboration of practitioners in defining the interpretation and implementing is critical for improved care for women and children. Realizing that this information deserves wide dissemination, Women’s Health and Education Center (WHEC) encourages its translations and adaptations.

Amniotic Fluid Disorders

Amniotic fluid is seldom considered important until polyhydramnios or oligohydramnios occurs, either of which may significantly impact perinatal survival. Amniotic fluid is dynamic, with large volume flows into and out of the amniotic compartment each day. This document explores what is known about the normal mechanisms affecting the formation and removal of amniotic fluid, including fetal urination, swallowing, lung liquid and intramembranous absorption. In addition, the changes in amniotic fluid volume and composition across gestation, in order to help us understand its normal regulation are examined. The various treatment options available for amniotic fluid volume abnormalities are discussed. The goal of this review is to offer the reader a complete understanding of the known mechanisms and functioning of amniotic fluid volume regulation, and their connection with disease states.

Medical Disorders and Contraception

Decisions regarding contraception for women with coexisting medical problems may be complicated. In some cases, medications taken for certain chronic conditions may alter the effectiveness of hormonal contraception, and pregnancy in these cases may pose substantial risks to the mother as well as her fetus. In addition, differences in content and delivery methods of hormonal contraceptives may affect patients with certain conditions differently. When selecting one of the many effective contraceptive methods available, healthcare providers and women need to consider each method’s risk/benefit profile relative to the specific underlying illness. The purpose of this document is to provide information to help healthcare providers and women with coexisting medical conditions make sound decisions regarding the selection and appropriateness of various hormonal contraceptives and facilitate use of contraceptive choices that do not exacerbate medical problems. Addressed in this document are; to recognize that increased risks are associated with pregnancy in women with various medical conditions and evaluate evidence-based risks and benefits of use of intrauterine devices (IUDs) in women with various medical conditions.

Genetic Counseling and Genetic Screening

The review discusses the principles of genetic counseling and genetic screening. Disorders amenable to genetic screening and prenatal diagnosis are also enumerated. Salient principles of the genetic counseling process are described. A variety of molecular diagnostic tests are available to determine whether an individual or fetus has inherited a disease-causing gene mutation. It can identify other family members or relatives at risk for the disorder or at risk for being a carrier. The gift of life can be “perfect” even in the presence of serious problems.

Robotic Gynecologic Surgery

Minimally invasive surgical techniques for performing hysterectomies and other gynecologic surgeries have been shown to reduce patient morbidity and shorten hospital stay. The purpose of this document is to review the recent adoption, experience, and applications of robot-assisted laparoscopy in gynecologic surgery. It will likely continue to develop as more gynecologic surgeons are trained and more patients seek minimally invasive surgical options. Well-designed, prospective studies with well-defined clinical, long-term outcomes, including complications, cost, pain, return to normal activity, and quality of life, are needed to fully assess the value of this new technology. Surgical innovation is necessary. There are ethical and societal issues that remain incompletely understood about the use of robotic surgery.

Healthy Ageing: A Call For Global Action

Populations around the world are rapidly ageing. Ageing presents both challenges and opportunities. Ageing is the progressive accumulation of changes with time that are associated with or responsible for the ever-increasing susceptibility to disease and death which accompanies advancing age. These time-related changes are attributed to the ageing process. Societies that adapt to this changing demographic and invest in Healthy Ageing can enable individuals to live both longer and healthier lives and for societies to reap the dividends. Current public-health approaches to population ageing have clearly been ineffective. A new framework for global action is required. This review offers a framework for all sectors focus on common goals so that action can be coordinated and balanced. It also explores what health might mean to an older person and how public-health strategy might be framed to foster it. Throughout this review it is emphasized that all aspects of an older person’s environment need to work together in an integrated way if healthy ageing is to be achieved. Finally, the review identifies the key steps that need to be taken next.

Ending Child Marriage: A Call For Global Action

Today, there are nearly 70 million child brides worldwide. Every 2 seconds a young girl is forced into marriage. Be part of the generation that changes that. This review, recommendations and practice bulletin on child marriage are an introduction to various global projects and programs, for ending child marriage, for the healthcare providers. The silence on the plight of child brides must end. Tackling child marriage is a daunting but possible task, requiring political-will and proactive multi-faceted strategies at the international, national and community levels. Families, community leaders and the broader community are also essential in helping change norms and expectations about what is possible for girls and women. With international networks The Women’s Health and Education Center (WHEC) will continue its work to prevent child marriages worldwide. Ending child marriage is indeed a mandatory task if we are to make progress in global efforts to attain the Sustainable Development Goals (SDGs). These standards also act as an accountability measure: governments have to report to the committee that oversee them about how they are implementing the standards. They can be used to hold governments accountable for failure to implement and enforce their obligations related to child marriage under these conventions. Setting the minimum age of marriage at 18 years provides an objective rather than subjective standard of maturity, which safeguards a child from being married when they are not physically, mentally or emotionally ready. Why allow children to marry at an age when for example, they do not have the right to vote or enter into other contracts recognized in law? The most widely accepted definition for a child is 18 years, in line with the Convention on the Rights of the Child. A minimum age of 18 years will also help to ensure that children are able to give their free and full consent to marry and have the minimum level of maturity needed before marrying.

HELLP Syndrome – Diagnosis and Management

Intravascular hemolysis, elevated liver function tests and low platelets counts (thrombocytopenia) also known as HELLP syndrome has been recognized as a complication of severe preeclampsia and eclampsia for many decades. The purpose of this document is to describe the pathogenesis, diagnosis and management of this syndrome. The presence of this syndrome is associated with increased risk of adverse outcome for both mother and fetus. This review will explain the controversies surrounding the diagnosis and management of this syndrome. Recommendations for the counseling of these women are also provided based on the results of recent studies.

Contraception: Depot Medroxyprogesterone Acetate

An unintended pregnancy represents a lost opportunity for preconceptional care for the fetus and a higher risk of pregnancy-related morbidity in the mother. Unintended pregnancies have been also associated with higher rates of unhealthy behaviors, such as smoking or alcohol use, and the lower rates of prenatal vitamin use, which increase the risk of low-birth weight infants and other adverse pregnancy outcomes. A woman’s use of her contraceptive method is affected by features of the method itself (dosing frequency, ease of use, cost and availability) as well as by her perceptions about the method. The purpose of this document is to describe advantages and disadvantages of depot medroxyprogesterone acetate (DMPA) use by individual adolescent and adult women. It also evaluates evidence regarding short- and long-term effects of DMPA on skeletal health. Counseling of all reproductive-age women, about the importance of maintaining a healthy lifestyle to minimize risks of osteoporotic fractures later in life, is essential. The review utilizes an evidence-based approach to the recently approved black box changes in DMPA product labeling.

Learning and Innovation Network for Knowledge and Solutions (PPT)

WHEC Global Health Line (WGHL) through its Learning and Innovation Network for Knowledge and Solutions aims to catalyze collaborative networks – cutting across disciplines, sectors, and borders – that seek science and technology-based solutions to development challenges.

Preparing the next generation of healthcare providers in the international arena, deepening their knowledge and improving the skill set for a career in global health and global governance is urgently needed. Programs are needed for healthcare providers to provide them with academic training and practical knowledge to assist them in providing national and international health care. Join the efforts – we welcome everyone.