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Bacterial infections around the time of childbirth (peripartum infections) account for about one-tenth of maternal deaths globally. In addition to the high risk of mortality and acute morbidity, women who experience peripartum infections are also vulnerable to serious long-term disabilities such as chronic pelvic pain, fallopian tube blockage and secondary infertility (the inability to become pregnant or carry a pregnancy to term after the birth of one or more children). Peripartum infections also pose a threat to the lives of newborns – maternal infections during childbirth cause approximately 1 million newborn deaths annually.
The World Health Organization (WHO) has launched a new guidance to help health professionals and policy makers reduce the global burden of maternal infections and their complications around the time of childbirth.
The WHO recommendations for prevention and treatment of maternal peripartum infections consolidate research and evidence on effective interventions to reduce the global burden of childbirth-related maternal infections. It provides guidance on best practice for the routine use of minor procedures (such as pubic hair shaving and vaginal examinations for labor assessment), use of antiseptic agents for vaginal and caesarean birth, and the use of antibiotics as a preventative measure in situations where there is a potential risk of infection – such as pre-labor rupture of membranes, meconium-stained amniotic fluid (when the first stool of an infant is expelled into the amniotic fluid), and perineal tears, as well as obstetric procedures such as the manual removal of the placenta, operative vaginal birth (use of forceps or vacuum), episiotomy and caesarean section.
Recommendations on treatment include a focus on the antibiotic management of chorioamnionitis (an inflammation of the fetal membranes due to a bacterial infection) and postpartum endometritis (an inflammation of the endometrium, the inner lining of the uterus).
A common intervention for safeguarding against the health risks posed by maternal perinatal infection is the use of antibiotics for prophylaxis (as prevention) and treatment. The overuse – or misuse – of antibiotics however, has implications for the success of global efforts to contain the emergence of resistant bacteria strains, and consequently poses a significant risk for global health. The WHO recommendations for prevention and treatment of maternal peripartum infections underscore the importance of appropriate use of antibiotics and antimicrobials, as well as efforts to reduce antimicrobial resistance.
With its focus on quality of care around the time of childbirth, the new guidance includes recommendations which align with the recently launched Global Goals for Sustainable Development, and the new Global Strategy for Women's, Children's and Adolescents' Health. The guideline will be useful for a wide range of people working across the health system in all countries, including health professionals and managers who are responsible for developing national and local health-care protocols and policies, as well as those who directly provide care of pregnant women and women who just give birth, including obstetricians, midwives, general medical practitioners and nurses.