Turning Disaster into an Opportunity for Quality Improvement in Essential Intrapartum and Newborn Care Services in the Philippines: Pre- to Posttraining Assessments.

Background. On 8 November 2013, supertyphoon Haiyan made landfall in the Philippines, severely disrupting health service delivery. Reestablishment of essential services for birthing mothers and their newborns became high priority. Methodology. Following a baseline assessment, an Essential Intrapartum and Newborn Care (EINC) training package was implemented and posttraining assessments (1 and 3 months after training) were undertaken. Results. Baseline assessments (n = 56 facilities) revealed gaps in provider's skill and shortage of life-saving commodities. Facilities lacked newborn bags/masks (9%), towels (6%), and magnesium sulfate (39%). Service providers lacked skills in partograph use (54%), antenatal steroid (44%) use, and breastfeeding initiation (50%). At 3 months after training (n = 51 facilities), dramatic increases in correct partograph use (to 92%), antenatal steroid use (to 98%), breastfeeding initiation (to 86%), kangaroo mother care (to 94%), availability of magnesium sulfate (to 94%), and bag/masks (to 88%) were documented. Gaps persisted for skills in assisted vaginal delivery and removal of placental fragments. Conclusion. Health services were severely disrupted after supertyphoon Haiyan. Our study demonstrates that essential birthing services and quality improvements to strengthen local health systems can be restored in a timely manner even in immediate postdisaster settings.

Placental growth hormone, fetal growth and the IGF axis in normal and diabetic pregnancy.

Gestational diabetes mellitus (GDM) and pre-gestational diabetes are known to pose risks to the mother and developing fetus, often related to abnormal fetal growth. One potential mediator of maternal effects on fetal growth is Placental Growth Hormone (PGH). PGH is produced by the syncytiotrophoblast and found predominantly in the maternal circulation. It progressively replaces pituitary growth hormone (hGH) in the human maternal circulation from mid-gestation onwards, peaking towards term. PGH appears to be an important potential regulator of maternal insulin resistance in human pregnancy and may influence fetal growth both by modifying substrate availability and through paracrine actions in the placental bed. The details of PGH regulation remain relatively poorly understood, but current evidence does suggest a central role in growth restricted pregnancies. There is currently less evidence of a pathophysiologic role in production of the macrosomic fetal phenotype commonly seen in response to hyperglycaemia, although our recent in vitro studies do raise the possibility of feto-placental feedback as a mechanism of growth modulation.

[Diagnosis and treatment of gestational diabetes--the Graz model]. / Diagnose und Behandlung des Gestationsdiabetes--das Grazer Modell.

OBJECTIVE: Despite the fact that gestational diabetes mellitus (GDM) is a common problem in pregnancy, a good proportion of cases of GDM is either not recognized or treated only inadequately. The main problems are a general trend of underestimating the risk of morbidity, the lack of integration into obstetric care regulations and heterogeneous guidelines regarding the screening and treatment of GDM. METHODS: For decades, the Graz concept of diagnosis and therapy of GDM has offered a 1-step general screening of all pregnant women between gestational weeks 24 and 28; in addition, the option of measuring the amniotic fluid insulin concentration via amniocentesis at gestational weeks 31-32 allows to detect hyperinsulinemic fetuses who represent an obstetric high-risk group. CONCLUSION: Lower cutoff levels in the oral glucose challenge test as well as the measurement of amniotic fluid insulin concentrations, which have been implemented in the Graz model for a long time, offer a higher detection rate of GDM and allow a targeted therapy of fetuses at high risk. Screening and therapy of GDM are cost-effective instruments to improve obstetric outcomes, therefore obligatory screening and treatment for GDM should be recommended emphatically.

[Gestational diabetes in East Africa: a mostly disregarded disease?]. / Schwangerschaftsdiabetes in Ostafrika: eine Erkrankung, die zu wenig Beachtung findet?

The majority of all deliveries worldwide take place in the so-called developing world. Most recent epidemiological data have shown that the number of cases of type 2 diabetes mellitus and diabetes in pregnancy is steadily increasing worldwide. However, little is known about the prevalence of gestational diabetes in East Africa. Intrauterine exposure to the metabolic environment of maternal diabetes increases the risk of altered glucose homeostasis in the offspring, producing a higher prevalence of gestational diabetes mellitus in the next generation. Our preliminary results from an East African tertiary referral center show that in the year 2007 3.1% of all newborns had a birth weight of more than 4,000 g (mean 4,300 g, range 4,000- 5,600 g). During the same time period, the mean birth weight in the general population was only 3,046 g (range 600-3,200 g). Hence, personal experience in East Africa has convinced the authors that diabetes in pregnancy is grossly neglected. Besides infectious diseases like HIV/AIDS, the African continent is increasingly facing metabolic diseases such as type 2 diabetes mellitus and diabetes in pregnancy.

[The dilemma of diabetes in pregnancy: worldwide differences in diagnosis and management]. / Dilemma Schwangerschaftsdiabetes: Weltweite Unterschiede in Diagnostik und Therapie.

OBJECTIVE: Type 1 and type 2 diabetes in pregnancy as well as gestational diabetes mellitus (GDM) pose major risks to mother and fetus. We assessed to which extent two obstetric centers on two different continents coincide in their management of diabetes in pregnancy. METHODS: Within the scope of research activities between the Obstetric Department of the Medical University of Graz, Austria, and the Centre of Obstetric Medicine at the Mater Misericordiae Mothers' Hospital in Brisbane, Australia, current practices among the two obstetric centers in Austria and Australia were assessed. RESULTS: The management of type 1 and type 2 diabetes in pregnancy was almost identical, whereas major differences were found in the management of GDM. CONCLUSION: Standardization of screening methods in diabetes in pregnancy remains challenging. National and international consensus has yet to be achieved in order to put a hold to the 'diabetic epidemic' we are going to face in the future.