Management strategies for pregnancy

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Pregnancy and childbirth are intensely studied with the hope of improving the health and wellbeing of both mother and child.  The physician’s first priority is to ensure the health of the mother during pregnancy, so procedures such as Caesarean sections should be undertaken only when an assessment has been carried out on the relative risks and benefits to the mother, as well as ensuring safe delivery of the child. Decisions such as these become even more fraught when a mother suffers trauma or disease, rendering her close to the point of death – then, the physician must decide whether and how to manage the mother’s vital signs to aim for safe delivery. Two new articles in BMC Medicine this month shed further light on these important topics.

In a research article, the WHO Global Survey on Maternal and Perinatal Health Research Group assess the risks associated with Caesarean sections in low and middle income (LMIC) countries, focusing in this report on countries in Africa and Latin America. Their results suggest that when a Caesarean section is not medically indicated, elective Caesareans should be discouraged due to the much higher risks of severe maternal outcomes associated with the procedure. This confirms work that the WHO research group carried out earlier this year in far-eastern countries.

Ezmaelizadeh and colleagues systematically review strategies to manage a brain-dead mother to ensure a healthy delivery where possible, and also to preserve the mother’s organs for donation after delivery. This is a particularly distressing time for those involved, with potentially controversial ethical and social considerations to factor in to the decision-making process. This review should help in providing a clear indication of best practice.

Interestingly, in the UK, the NHS is about to launch specialist support centres following a rise in the reported cases of birth trauma. The hope is that centralised specialist care will allow faster uptake of the latest research, such as these two studies, to give the best possible care to pregnant women whatever the risks and complications.