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Guideline

WHO recommendations on maternal health: guidelines approved by the WHO Guidelines Review Committee, second edition. Geneva: World Health Organization; 2025

Year of Publication
2023
Issuing Institution
World Health Organization
Links
MAGICapp,MagicApp,iris.who.int

Recommendations

372 included recommendations

The implementation of community mobilization through facilitated participatory learning and action (PLA) cycles with women’s groups is recommended to improve maternal and newborn health, particularly in rural settings with low access to health services. Participatory women’s groups represent an opportunity for women to discuss their needs during pregnancy, including barriers to reaching care, and to increase support to pregnant women.

Status
New

Context specific recommendation

Only in specific contexts

In low HIV burden settings (less than 5% HIV prevalence in the population being tested), catch-up testing postpartum can be considered for women of HIV-negative or unknown status who missed early antenatal contact test or retesting in late pregnancy at a third trimester visit as part of the effort to eliminate mother-to-child transmission of HIV. Countries could consider this only for women who are in serodiscordant relationships, where the partner is not virally suppressed on ART, or have other known ongoing HIV risk in late pregnancy – at a third trimester visit.

Status
New

Preventive chemotherapy (deworming), using annual or biannual single-dose albendazole (400 mg) or mebendazole (500 mg), is recommended as a public health intervention for all non-pregnant adolescent girls and women of reproductive age, including women postpartum and lactating women, living in areas where the baseline prevalence of any soil-transmitted helminth infection is 20% or more among adolescent girls and women of reproductive age, in order to reduce the worm burden of soil-transmitted helminths. Remarks: Biannual administration is recommended where the baseline prevalence exceeds 50%

Status
New

Recommended in favor

Strong

In endemic communities with Schistosoma spp. prevalence of 10% or higher, WHO recommends annual preventive chemotherapy with praziquantel in a single dose for ≥ 75% up to 100% of pregnant women after the first trimester, and non-pregnant adolescent girls and women of reproductive age, including postpartum and/or lactating women, to control schistosomiasis morbidity and move towards eliminating the disease as a public health problem.

Status
New

Recommended in favor

Strong

In endemic communities with Schistosoma spp. prevalence of less than 10%, WHO suggests one of two approaches based on the programmes’ objectives and resources: (i) where there has been a programme of regular preventive chemotherapy, continuing preventive chemotherapy at the same or a reduced frequency towards interruption of transmission; and (ii) where there has not been a programme of regular preventive chemotherapy, a clinical approach of test-and-treat, instead of preventive chemotherapy targeting a population.

Status
New

Context specific recommendation

Only in specific contexts

The following signs should be assessed during each postnatal care contact and the newborn should be referred for further evaluation if any of the signs is present: stopped feeding well, history of convulsions, fast breathing (breathing rate ≥60 per minute), severe chest in-drawing, no spontaneous movement, fever (temperature ≥37.5 °C), low body temperature (temperature <35.5 °C), any jaundice in first 24 hours of life, or yellow palms and soles at any age. The family should be encouraged to seek health care early if they identify any of the above danger signs in-between postnatal care visits

Status
New

Recommended in favor

Strong

In settings with recent (within the last five years) and reliable data that indicate a high infant mortality rate (greater than 50 per 1000 live births) and a high prevalence of maternal vitamin A deficiency (> 10% of pregnant women with serum retinol concentrations < 0.70 µmol/L), providing newborns with a single oral dose of 50 000 IU of vitamin A within the first three days after birth may be considered to reduce infant mortality.

Status
New

Context specific recommendation

Only in specific contexts

A minimum of four postnatal care contacts is recommended. If birth is in a health facility, healthy women and newborns should receive postnatal care in the facility for at least 24 hours after birth. If birth is at home, the first postnatal contact should be as early as possible within 24 hours of birth. At least three additional postnatal contacts are recommended for healthy women and newborns, between 48 and 72 hours, between 7 and 14 days, and during week six after birth.

Status
New

Recommended

Prior to discharging women and newborns after birth from the health facility to the home, health workers should assess the following criteria to improve maternal and newborn outcomes: • the woman’s and baby’s physical well-being and the woman’s emotional well-being; • the skills and confidence of the woman to care for herself and the skills and confidence of the parents and caregivers to care for the newborn; and • the home environment and other factors that may influence the ability to provide care for the woman and the newborn in the home, and care-seeking behaviour

Status
New

Recommended

Interventions to promote the involvement of men during pregnancy, childbirth and after birth are recommended to facilitate and support improved self-care of women, home care practices for women and newborns, and use of skilled care for women and newborns during pregnancy, childbirth and the postnatal period, and to increase the timely use of facility care for obstetric and newborn complications. These interventions are recommended, provided they are implemented in a way that respects, promotes and facilitates women’s choices and their autonomy in decision-making, and that supports women in taking care of themselves and their newborns

Status
New

The use of lay health workers including trained TBAs to deliver the following interventions is recommended, with targeted monitoring and evaluation: distribution of some oral supplementtype interventions to pregnant women (calcium supplementation for women living in areas with known low levels of calcium intake, routine iron and folate supplementation for pregnant women, intermittent presumptive therapy for malaria for pregnant women living in endemic areas and vitamin A supplementation for pregnant women living in areas where severe vitamin A deficiency is a serious public health problem); and initiation and maintenance of injectable contraceptives using a standard syringe

Status
New

For the sole purpose of reducing caesarean section rates, collaborative midwifery-obstetrician model of care (i.e. a model of staffing based on care provided primarily by midwives, with 24-hour back-up from an obstetrician who provides in-house labour and delivery coverage without other competing clinical duties) is recommended only in the context of rigorous research. This model of care primarily addresses intrapartum caesarean sections

Status
Maintained

Recommendation in research context

Only in research contexts

In settings with a high prevalence of syphilis (5% or greater), the WHO STI guideline suggests an on-site rapid syphilis test (RST) and, if positive, provision of a first dose of treatment and a rapid plasma reagin (RPR) test, and then, if the RPR test is positive, provision of treatment according to duration of syphilis (Strategy C). The WHO STI guideline suggests this sequence of tests and treatment rather than a single on-site RST (Strategy A) or a single on-site RPR test (Strategy B).

Status
Maintained

Recommended in favor

Conditional

In pregnant women with early syphilis, the WHO STI guideline suggests using benzathine penicillin G 2.4 million units once intramuscularly over procaine penicillin 1.2 million units intramuscularly once daily for 10 days. When benzathine or procaine penicillin cannot be used (e.g. due to penicillin allergy where penicillin desensitization is not possible) or are not available (e.g. due to stockouts), the WHO STI guideline suggests using, with caution, erythromycin 500 mg orally four times daily for 14 days or ceftriaxone 1 g intramuscularly once daily for 10–14 days or azithromycin 2 g once orally

Status
Retired

Recommended in favor

Conditional

In pregnant women with late syphilis (more than two years’ duration) or unknown stage of syphilis, the WHO STI guideline suggests benzathine penicillin G 2.4 million units intramuscularly once weekly for three consecutive weeks over procaine penicillin 1.2 million units intramuscularly once a day for 20 days. When benzathine or procaine penicillin cannot be used (e.g. due to penicillin allergy where penicillin desensitization is not possible) or are not available (e.g. due to stockouts), the WHO STI guideline suggests using, with caution, erythromycin 500 mg orally four times daily for 30 days.

Status
Retired

Recommended in favor

Conditional

All pregnant women who have recovered from Ebola virus disease (with conception prior to Ebola virus disease) should be enabled and encouraged to attend frequent Antenatal Care (ANC). If there is no risk of exposure to pregnancy-related fluids during the ANC visit, only standard precautions are required. Complications associated with childbirth and pregnancy should be managed at Ebola treatment centres (ETCs): and Ebola Infection Prevention and Control (IPC) measures should be used in addition to standard precautions

Status
Maintained

Recommended in favor

Strong

Children without confirmed Ebola virus infection who are exposed to the breastmilk of women with confirmed Ebola virus disease should be considered contacts. The child should stop breastfeeding and should undergo close monitoring for signs and symptoms of Ebola virus disease for 21 days. The child should be given a breastmilk substitute as needed. Post-exposure prophylaxis for Ebola virus disease can be considered for children exposed to the breastmilk of Ebola virus-infected women on a case-by-case basis and in accordance with existing research protocols

Status
Maintained

Recommended in favor

Strong

If a lactating woman and her breastfeeding child are both diagnosed with Ebola virus disease, breastfeeding should be discontinued, the pair should be separated, and appropriate breastmilk substitutes should be provided. However, if the child is under six months of age and does not have safe and appropriate breastmilk substitutes, or the child cannot be adequately cared for, then the option to not separate and continue breastfeeding can be considered

Status
Maintained

Recommended in favor

Strong

Antenatal corticosteroid therapy is recommended for women with a high likelihood of preterm birth from 24 weeks to 34 weeks of gestation when the following conditions are met: Gestational age assessment can be accurately undertaken; There is a high likelihood of preterm birth within 7 days of starting therapy; There is no clinical evidence of maternal infection; Adequate childbirth care is available (including capacity to recognize and safely manage preterm labour and birth; The preterm newborn can receive adequate care (including resuscitation, kangaroo mother care, thermal care, feeding support, infection treatment and respiratory support including continuous positive airway pressure [CPAP] as needed)

Status
Maintained

Context specific recommendation

Only in specific contexts

Nifedipine is recommended for acute and maintenance tocolytic therapy for women with a high likelihood of preterm birth for the purpose of improving newborn outcomes, when the following conditions are met: Spontaneous preterm labour is suspected or diagnosed; Gestational age is accurately assessed to be between 24 weeks 0 days and 33 weeks 6 days; There is no evidence that tocolysis is contraindicated (such as vaginal bleeding, placental abruption or intrauterine infection); It permits a single course of antenatal corticosteroids to be administered and/or enables transfer of the mother to a facility where, upon birth, the preterm infant can receive adequate care (including resuscitation, kangaroo mother care, thermal care, feeding support, infection treatment and respiratory support including continuous positive airway pressure as needed); Adequate birth care is available (including capacity to recognize and safely manage preterm labour and birth)

Status
Maintained

Context specific recommendation

Only in specific contexts