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The Any age can be affected, but the highest incidence amount of hemosiderin deposited is increased compared (18%) is between 20 and 29 years. Sex Ratio: approximately 1:1, but 3:2 males Summary of Essential Features and Diagnostic to females in children. Criteria Acute and chronic pain as the result of acute hemarthroPain Quality: initially the pain is acute and intense. It is sis with chronic synovial cartilaginous and bony degenfrequently described as throbbing, smarting, and stingeration is exacerbated by spontaneous and traumaing, and marked exacerbations of stabbing pain occur related hemorrhage. Thus, it is particularly intense where there are skin creases or flexures or where Diagnostic Criteria pressure is applied, such as palms, soles, genitalia, ears, Pain associated with hemophiliac arthropathy must sator resting surfaces. Despite the destruction of all cutaneous nerve endings, full thickness bums are often painful with 1. Spontaneous intracapsular hemorrhages in an india quality described as deep, dull, or aching. Demonstrable synovial bleeding with or without Intensity and Duration: the pain tends to diminish in bony joint contour abnormalities. In addition, the quality of the pain changes, and at one to two weeks after the Differential Diagnosis bum is usually described as sore, aching, tender, tiring, In the presence of a severe (less than 0. After three or four weeks it is described as mophilic factor deficiency, no other diagnosis is possiitchy or tingling. Relief may be promoted by the use of opioid premedication prior to procedures, Code X34. Complications Burns (1-15) If healing occurs, it is unusual to have persistent pain unless deep structures (muscle, bones, major nerves) are Definition involved. Cellulitis in burnt areas or donor sites may Acute and severe pain at first, following bums, later conlead to a marked increase in the severity of pain. Social and Physical Disability Site this is most frequent where the bum is extensive, and Anywhere on the body surface and deep to it. Main Features Pathology Page 53 Loss of skin integrity with consequent loss of fluid and pressure sensations. Occurrence and Duration: most thermoregulation and an increased likelihood of infecdays per week, usually every day for most of the day. Burns are classified in three degrees of severity Occasionally in long-standing severe cases pain may based on burn depth. A partial thickness burn involves epibating Factors: emotional stress, anxiety and depresdermis and dermis at varying depths, and a full thickness sion, physical exercise, alcohol. Electrical burns may cause considerable damage Associated Symptoms to deeper tissues by direct effect and by occlusion of Many patients have anxiety, depression, irritability, or blood vessels. The Muscle tenderness occurs but may also be found in other agents responsible may be thermal, electrical, or chemiconditions and in normal individuals.

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Funded by the Bill & Melinda Gates Foundation, in the treatment arm, with the number needed to treat of the trial is being conducted in centers in Argentina, 100 women to prevent 1 case of eclampsia (Altman and South Africa, and Zimbabwe in populations with known others 2002); the number needed to treat fell to 63 for calcium dietary deficiencies. Interest has increased in the development toin for the treatment of eclampsia (Duley, Hendersonof a blood pressure monitor suitable for settings without Smart, and Chou 2010). In this study, However, limited evidence suggests that induction at normal levels of placental growth factor accurately more than 36 weeks of gestation reduces poor maternal predicted which women did not need delivery for preecoutcomes in mild preeclampsia (Koopmans and others lampsia within two weeks. For earlier gestations, the decision for delivery available as a rapid bedside diagnostic tool, shows 120 Reproductive, Maternal, Newborn, and Child Health promise as an adjunct to clinical assessment of women on reducing maternal deaths and stillbirths. However, with preeclampsia, particularly for its apparent ability to there was insufficient evidence for robust conclusions distinguish women who require intensive surveillance to be drawn (van Lonkhuijzen, Stekelenburg, and van and delivery from those who can be managed expecRoosmalen 2012). Obstruction usually 36 weeks gestation may reduce the risk of not achieving occurs at the pelvic brim, but may occur in the cavity a normal vaginal (cephalic) delivery by half, and may or outlet. Obstructed labor accounts for an estimated breech presentations at or beyond 36 weeks, but more 4 percent of maternal deaths (Lozano and others 2012), research is needed. Other outcomes, such as obstetric fistuTreating Obstructed Labor las, lead to considerable long-term maternal morbidity. In addition, women may ery may be used to assist women with obstructed labor prefer to deliver in the community without skilled at the pelvic outlet or low or mid-cavity. Operator training is vital in all facility Sepsis associated with pregnancy and childbirth is settings to maximize benefits and reduce morbidity among the leading direct causes of maternal mortality with vacuum and forceps deliveries. Symphysiotomy is an operation the global burden of maternal deaths (Khan and others in which the fibers of the pubic symphysis are par2006). Efforts to reduce maternal sepsis have largely potential subsequent pelvic instability and because it focused on avoiding the risk factors, with an emphasis is considered a second-best option has resulted in its on reducing the frequency of unsafe abortion, intrapardecline or disappearance from use in many countries. A Cochrane review are widely acceptable practices for preventing hospital evaluated evidence for maneuvers to relieve shoultransmissible infections. The evidence from available the evidence from this review of two small trials was Cochrane reviews is insufficient to determine whether insufficient to support or refute any benefits of these prophylactic antibiotics given with operative delivery or maneuvers. However, the use the Odon device has been developed to assist vaginal of antibiotics among women with a thirdor fourthdelivery. It consists of a film-like polyethylene sleeve that Antibiotic prophylaxis at cesarean delivery. Most of these interventions are included antibiotics was associated with a significant reduction in the Lives Saved Tool, developed to model the impact of in chorioamnionitis (moderate-quality evidence) and the interventions at different coverage levels (Walker, Tam, markers of neonatal morbidity. The Lancet Every Newborn Series term, and this practice should be avoided in its absence presents Lives Saved Tool modeling with estimates of lives (Wojcieszek, Stock, and Flenady 2014). Important interventions initiated in the antenatal or Vaginal application of antiseptics for cesarean delivery. The review covered preconception or adolescent care interventions, includes five trials involving 1,946 women.

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Although good facing intimate partner violence need to be able to options for safe abortion exist, these services remain 108 Reproductive, Maternal, Newborn, and Child Health unavailable in many countries because of legal barriers, Bakamjian, L. Pilot-Testing the Project, Johns Hopkins Bloomberg School of Public Health, Model in Ethiopia. Population Growth Perspectives on Sexual and Reproductive Health 37 (3): and Economic Development: Policy Questions. Safe Abortion: Technical and Policy Guidance for and Uganda: Impact on Sexual and Reproductive Health Health Systems. Respiratory infections, diarrhea, and malaria remain important causes of under-five mortality after In 2015, an estimated 303,000 women died as a result the first month of life (Liu and others 2016). This chapter the decline is much slower for neonatal deaths (Liu discusses biomedical interventions for major causes of and others 2016). Metin Gulmezoglu, Department of Reproductive Health and Research, World Health Organization, Geneva, gulmezoglum@who. However, ruptured during the third stage of labor before the placenta is uterus, a possible consequence of obstructed labor, delivered. However, the contribution of 500 milliliters) (Westhoff, Cotter, and Tolosa 2013). Evidence from observational studies is graded low quality in the first instance and upgraded to moderate (or high) if large effects are yielded in the absence of obvious bias. In comparison with oxytocin, oral or sublingual to increase or decrease severe maternal morbidity or misoprostol was associated with an increased risk of mortality (Hofmeyr and others 2013). Interventions to Reduce Maternal and Newborn Morbidity and Mortality 117 Misoprostol does not require refrigeration and is Treating Postpartum Hemorrhage inexpensive and easy to administer. Continued vigilance for high-quality evidence supports these interventions, they adverse effects is essential. Additional research is needed allow easier assessment of the uterus and its contractilto further determine the relative effectiveness and the ity.

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Facilities should develop mechanisms for holding formal and informal meetings between staff and groups Caregivers/teachers should establish parent/guardian of parents/guardians. Fateachers should have a regularly established means of cilities should post the complaint and resolution procedure communicating to parents/guardians the existence of these where parents/guardians can easily see (or view) them. The ents/guardians is essential to promote their respective child caregiver/teacher should record parental/guardian participacare roles and to avoid confusion or conficts surrounding tion in these on-site activities in the facility record. In addition to routine meetings, special meetings can deal with crises and unique problems. Complaint and resoOne strategy for supporting parents/guardians is to facililution documentation records can help program directors tate communication among parents/guardians. The list should assist in developing resources, and recommend facility and include an annotation encouraging parents/guardians whose policy changes to the governing body. It is most helpful to children attend the same facility to communicate with one document the proceedings of these meetings to facilitate another about the service. The facility should update the list future communications and to ensure continuity of service at least annually. Facility-sponsored activities could take place outside facility hours and at other venues. Some parents/ Education Topics for Children guardians may resist providing this information. If so, the Health and safety education for children should include caregiver/teacher should invite them to view this exchange physical, oral, mental, emotional, nutritional, and social of information as an opportunity to express their own conhealth and should be integrated daily into the program of cerns about the facility (1). The specialist/professional safety, personal safety, what to do in an emergency, must also be certain that all communication shared with getting help and/or dialing 9-1-1 for emergencies); caregivers/teachers is shared directly with the parent/guardk) Confict management, violence prevention, and ian.