Perinatal Technologies

The Latin American Center for Perinatology, Women's Health and Reproductive Health (CLAP/WR) has developed several technologies and made them available to facilitate actions for improving the health care of women, pregnant women, newborns, and children. These technologies are designed for health care workers, specifically at the first and second levels of care, for the training of human resources at centers and in the community, and for strengthening knowledge on women's, maternal and perinatal health.

These technologies orderly present the normalcy criteria based on the distribution of values obtained from a well Latin American population; most of them result from research conducted by the CLAP/WR-PAHO/WHO team applying the greatest methodological rigor. The recommendations included are supported by up-to-date scientific evidence.

Maternal & Fetal Health

Tools for the provision of care and training at health care facilities.

Appropriate Technology/Standards
Publication year: 1990. Last updated in 2010.

Description: tape measure for gauging the height of the uterus during pregnancy. This is a support technology for antenatal monitoring; it makes it easier for health care workers at first and second level centers and hospitals to conduct a proper monitoring of pregnancy.

Content: This tape is used to control fetal growth, and it serves as a reminder of the patterns for the surveillance of maternal and fetal health and the monitoring of fetal growth restriction during pregnancy. Its two sides - front and back - are white and yellow, respectively.

Front side: 50-cm tape measure with 0.5-cm divisions. It contains the technique for the measurement of uterine height, the normal values of uterine height at term and the normal systolic and diastolic blood pressure patterns during pregnancy.

Back side: It contains patterns of uterine height, maternal weight gain, estimated fetal weight, uterine contractions per hour, by gestational age.

Available in Spanish, English, Portuguese and French.

Target audience: Health care workers.

Formats available: Inextensible, and washable tape made of synthetic material.

Tools for the provision of care and training at health care facilities .

Appropriate Technology/Standards.

Publication year: 1990. Last updated in 2010.

The pocket gestogram is a support technology for antenatal monitoring; it makes it easier for health care workers at first and second level centers and hospitals to conduct a proper monitoring of pregnancy.

Description: It consists of two 12-cm discs; the front disc is mobile and turns sliding over the fixed disc on the back.

Content: Measurements of some parameters selected on account of their reliability and precision were added to the obstetric calendar to calculate several parameters, including amenorrhea, to monitor fetal growth and vitality, to estimate pregnancy age and the newborn’s age, and to check that the pregnant woman’s weight gain, blood pressure, and uterine contractility are normal.

Moving disc: This disc turns over a calendar. Setting the red arrow on the first day of the last menses, the user locates the date of the visit and obtains the amenorrhea as completed weeks. The values to be compared are to the left of the week found: 90th and 10th percentiles of uterine height, 90th and 25th percentiles of maternal weight gain, 95th and 5th percentiles of fetal abdominal girth. This disc allows the detection either of fetal growth restriction (when measurements are under the lowest values of the appropriate percentiles), or macrosomia (when they are over the corresponding percentiles), variations in the duration of pregnancy, or contractility greater than appropriate for gestational age.

Back side: If the date of the last menstruation is not known, this side of the disc allows the user to estimate amenorrhea with a known error, based on the ultrasound measurements of the embryo/fetus. From the 20th week onwards, it presents the 10th and 90th percentile values of fetal weight and the 50th percentile values of length corresponding to each week. It comes with user instructions.

Available in Spanish, English, and Portuguese.

Target audience: Health care workers.

Formats available: Pocket format in plastic-coated cardboard.

Tools for the provision of care and training at health care facilities.

Appropriate Technology/Standards.

Publication year: 1990. Updated in 2006.

Description: This is a support technology for antenatal monitoring; it makes it easier for health care workers at first and second level centers and hospitals to conduct a proper monitoring of pregnancy. It consists of two 25-cm discs applied on a 40 cm by 53 cm cardboard surface; one of the discs moves (left) and the other one is fixed (right). The instructions are printed on the instrument.

Fixed disc: If the date of the last menstruation is not known, the fixed disc allows the estimation of amenorrhea with a known error based on the ultrasound measurements of the embryo/fetus. From the 20th week onwards, it presents the 10th and 90th percentile values of fetal weight and the 50th percentile values of length corresponding to each week.

Available in Spanish, English, and Portuguese.

Target audience: Health care workers.

Formats available: Cardboard wall model that can be attached to a flat surface by means of screws or nails.

Tools for the provision of care and training at health care facilities.

Appropriate Technology/Standards.

Publication year: 1992. Updated in 2006.

Description: This is a support technology that helps health care workers at health care centers and delivery rooms conduct a proper monitoring of pregnancy and childbirth.

Content: This fetal stethoscope has been added illustrations of the auscultation technique and records of normal patterns and deceleration of fetal heart rate from the 20^th week of pregnancy on, associated with uterine contractions in pregnancy and childbirth, its interpretation, and recommendations. The instructions for use are printed on the instrument. It comes with the “Card and Banner for the Clinical Management of Uterine Contractility and Fetal Heart Rate during Pregnancy and Childbirth” as support material.

Available in Spanish, English, French and Portuguese.

Target audience: Health care workers.

Formats available: Fetal illustrated, washable stethoscope made of plastic; highly resistant and with high acoustic conductivity.

Tarjeta plastificada de 12.5 cm por 22.5 cm

Tools for the provision of care and training at health care facilities.

Appropriate Technology/Standards.

Publication year: 2006.

Description: 12.5 cm by 22.5 cm plastic coated card for the staff of health care facilities and delivery rooms, to facilitate clinical monitoring of fetal health through fetal heart rate and uterine contractility during pregnancy and childbirth.

Content: It reminds the user of the maximum values of palpation-detected uterine contractility patterns according to gestational age during pregnancy, the characteristics of uterine contractility during labor and fetal heart rate during pregnancy and between contractions during delivery.

Available in Spanish and English.

Target audience: Health care workers.

Formats available: 12.5-cm by 22.5-cm pocket format in plastic coated cardboard; both the front and back are colour-printed. Size of the wall banner: 50 cm by 50 cm. (Spanish).

Tools for the provision of care and training at health care facilities.

Appropriate Technology/Standards.

Publication year: 1991.

Description: Form designed to plot cervical dilation as a function of time, and to quickly assess the progress of labor. Use instructions are printed on the tool.

Content: The partogram includes reference patterns corresponding to the lower limit (10^th percentile) of the course of cervical dilation as a function of time, considering four subgroups based on parity, the mother's position during the dilation period and the state of the membranes when the dilation is 4 cm. This technology is complemented by the warning curves chart (Normogram), which allows to rapidly assess the progress of delivery, to prevent prolonged delivery and facilitate timely actions.

Available in Spanish, English, and Portuguese.

Target audience: Health care workers. Training of health care workers.

Formats available: Printed form in A4 format.

Tools for the provision of care and training at health care facilities.

Appropriate Technology/Standards.

Publication year: 1991. UNDER REVIEW.

Description: 16-cm by 20-cm banner showing warning curves of cervical dilatation as a function of time as labour progresses.

Content: The warning curves correspond to the lower limit (10th percentile) of the evolution of cervical dilation as a function of time. Four subgroups are considered based on parity, the mother's position during the dilation period and the state of the membranes when the cervix dilation is 4 cm. This technology allows to prevent prolonged delivery and facilitates timely actions.

Available in Spanish, English, and Portuguese.

Target audience: Health care workers. Training of health care workers.

Formats available: Washable polystyrene banner.

Tools for the provision of care and training at health care facilities
Appropriate technology.

Publication year: 1994.

Description: 20- by 25-cm template with holes ranging from 2 to 10 cm in diameter and one-cm increments.

Contents: This tool allows to check the degree of cervical dilation estimated by vaginal digital exam, as well as to teach how to estimate cervical dilation.

Available in Spanish and English.

Target audience: Health care workers. Health care workers’ training.

Formats available: Washable polystyrene banner.

Tools for the provision of care and training at health care facilities.

Appropriate Technology.

Publication year: 1994. Last updated 2008.

Description: 11-cm by 14-cm triptych plastic coated banner designed to support the health care teams at hospitals and health care centers in the advocacy for and protection of sexual and reproductive health.

Content: This tool includes information for health care workers on the early diagnosis of breast and cervical cancer and the diagnosis and treatment of sexually transmitted infections. It also includes information on contraception to facilitate guidance on the provision of family planning methods.

Available in Spanish, English, French and Portuguese.

Target audience: Health care workers.

Formats available: 11-cm to 14-cm plastic-coated cardboard banner in triptych format, printed on both sides.

Tools for the provision of care and training at health care facilities.

Appropriate Technology/Standards.

Publication year: 1993. Updated in 2006.

Description: 22-cm by 9-cm plastic coated banner designed to facilitate the staff of health care centers, hospitals and maternity homes, the assessment of maternal weight for each gestational age, fetal growth, and maternal nutrition during pregnancy.

Content: Starting at week 13, the banner shows the values corresponding to the 10th and 90th percentiles of uterine height, the 25th and 90th percentiles of maternal weight gain and the 10th and 90th percentiles of maternal weight for height for each gestational age. Use instructions are printed on the tool.

Available in Spanish, Portuguese and English.

Target audience: Health care workers.

Formats available: 22-cm by 9-cm plastic coated cardboard banner printed on both sides.

Family and Community Tools/Information & Communication.

Publication year: 1994.

Description: DVD.

Content: message to promote antenatal monitoring .

Available in Spanish.

Target audience: Pregnant women, family, and community.

Duration: 20 minutes.

Juego participativo del camino del embarazo

Tools for families and communities.

Appropriate Technology.

Publication year: 1993. Updated in 2009.

Description: 36-cm by 53-cm cardboard board. It includes the game components and instructions.

Content: This participatory game seeks to promote pregnancy care, starting already in the pre-conception period and through pregnancy. Through active and entertaining participation, this game helps reinforce and expand the players’ knowledge about important aspects of pregnancy and its care, correct misinformation about these issues and develop positive attitudes towards actions that promote and protect health in general and during the pregnancy period in particular.

The board has 40 pictures, one after the other, drawing a path. They represent the weeks of pregnancy. The path is divided into 9 sectors corresponding to the 9 months of pregnancy. The game also brings 40 cards, each containing statements, questions and answers, and instructions; the cards will be placed in the matching places on the board. Finally, there is die and six coloured tokens, one for each player.

Available in Spanish.

Target audience: Community in general and pregnant women specifically.

Formats available: Also available in a put-together version.

Newborn Health

Tools for the provision of care and training at health care facilities.

Appropriate Technology/Standards.

Publication year: 1990. Updated in 2006.

Description: Tape measure to gauge the newborn’s length, head circumference and mid-arm circumference at birth.

Content: This tape measure is used to estimate the newborn’s gestational age by measuring the head circumference, to identify low birth weight based on the mid-arm circumference, and to assess the nutritional status. It has two sides: front (white) and back (pink).

Front side: This side has a 55-centimeter scale printed with half-centimeter divisions. At 9.5 centimeters, the printed lines are thicker, as a reference to determine low birth weight when measuring the mid-arm circumference. On the right end it displays the technique for measuring the head circumference, the newborn’s length, and mid-arm circumference.

Back side: This side contains the normal maximum (P90) and minimum (P10) weight values for gestational age and the median (P50), maximum (P95) and minimum (P5) values for the gestational age based on the measurement of the head circumference.

Available in Spanish, French, English, and Portuguese.

Target audience: Health care workers.

Formats available: Inextensible and washable tape made of synthetic material.

Tools for the provision of care and training at health care facilities.

Appropriate Technology/Standards.

Publication year: 2010.

Description: This measuring tape allows to measure the newborn’s length, head circumference and mid-arm circumference at birth.

Content: It allows to discriminate preterm and term newborns through the measurement of the head circumference, taking as a reference the 50th percentile (P50) of the estimation of the Gestational Age for the Head Circumference in premature newborns developed by CLAP/WR. Both the front and back sides show a printed 55-centimetre scale with half-centimetre divisions. On the right end it displays the technique for measuring the head circumference. From centimetre 20 to 35, the printing is red. If the head circumference measurement falls between these values, the newborn is very likely preterm. A legend printed in white in this segment of the tape warns about this fact, and about the need to refer the newborn to a place that offers an adequate level of care.
If no scales are available, a mid-arm circumference under 9.5 centimetres suggests the newborn has a low birthweight, in which case, the necessary actions must also be considered to ensure the newborn receives better care.

Available in Spanish, French, English, and Portuguese.

Target audience: Aimed at community health promoters (CHPs) and community trainers.

Available formats: Inextensible and washable tape made of synthetic material.

Tools for the provision of care and training at health care facilities.

Appropriate Technology/Standards.

Publication year: 1994.

Description: 23-cm by 6-cm plastic coated banner containing a weight gain table corresponding to the lower limit of the previous weight gain pattern developed by CLAP.

Content: This tool allows to estimate the minimum normal weight gain expected at each visit, based on the infant’s weight at the previous visit, simplifying the interpretation of the child's weight gain since the last control. Applicable to children of both sexes with inter-visit intervals ranging from 10 to 60 days after the previous control. Use instructions are printed on the tool.

Available in Spanish. Portuguese and English in process.

Target audience: Health care workers.

Available format: 23-cm by 9-cm plastic coated cardboard banner printed on both sides.

Tools for the provision of care and training at health care facilities.

Manuals, Guides and Standards.

Publication year: 1994. Updated in 2009.

Publication: CLAP’s Scientific Publication 1304; 41 pages.

Content: This publication supports the health team in promoting and protecting children’s health during outpatient care. It contains information on anthropometric tools, techniques and interpretation; evaluation, behavior, attitudes, characteristics, conduct, alerts and psychosocial assessment of bio-psychomotor development, detection of vision and hearing problems, prevention of accidents, guidance on immunizations, oral health and breastfeeding. The information is complemented by weight, length/height, and head circumference charts.

Available in Spanish and Portuguese.

Target audience: Health care workers.

Formats available: 39-cm by 29-cm “flipchart” format, made of hard cardboard to be kept at sites where children are monitored.

Tools for the provision of care and training at health care facilities.

Standards.

Publication year: 1991. Updated in 2009.

Description: 66 cm by 55 cm wall banner.

Content: This guide shows the behaviours expected in term children at a low risk for presenting disorders. It is distributed for educational purposes to remind the health care team of relevant aspects of development. It is expected to facilitate the family’s communication and participation, clarifying doubts, and anticipating the timeline of such changes, to favor stimulation opportunities.
Available in Spanish and Portuguese. English in process.

Target audience: Health care workers. Training in education of health care resources.

Formats available: Wall banner printed on four-colors; plastic-coated cardboard. 66 cm by 56 cm.

Health Education

Family & Community Tools/Information & Communication.

Publication year: 1994.

Description: DVD.

Content: message to promote antenatal monitoring.

Available in Spanish.

Target audience: pregnant women, family and community.

Duration: 20 minutes

Tools for families and communities.

Appropriate Technology.

Publication year: 1993. Updated in 2009.

Description: 36-cm by 53-cm cardboard board. It includes the game components and instructions.

Available in Spanish.

Target audience: Community in general and pregnant women specifically.

Formats available: Also available in a put-together version.

Evolución esquemática de las conductas del desarrollo

Tools for the provision of care and training at health care facilities.

Standards.

Publication year: 1991. Updated in 2009.

Description: 66 cm by 55 cm wall banner.

Available in Spanish and Portuguese. English in process.

Target audience: Health care workers. Training in education of health care resources.

Formats available: Wall banner printed on four-colors; plastic-coated cardboard. 66 cm by 56 cm.

Data systems

El Sistema de Información Perinatal (SIP) es un estándar de OPS para el registro clínico de la atención en servicios de salud dirigidos a la mujer, embarazo, parto y recién nacido. Fue creado por el Centro Latinoamericano de Perinatología – Mujer de la Salud y Reproductiva (CLAP/SMR) de la OPS en 1983.

SIP Plus, es la versión web del SIP. Contiene módulos de atención básica y de enfermedad materna severa (Near Miss) en el embarazo; módulos de parto y para el recién nacido durante la hospitalización postnatal (SIPNEO); registro de anomalías congénitas; módulos para mujeres en situación de aborto (SIP A) y, también, para registrar infecciones respiratorias graves durante el embarazo (ej.: COVID 19), entre otros.

El SIP consta, además, con herramientas informáticas para el análisis de los datos registrados en los módulos clínicos. Estas herramientas, de diseño amigable para personal de salud, permiten generar reportes automáticos de grupos de indicadores demográficos, carga de enfermedad, intervenciones y resultados. Además, se han desarrollado reportes a medida a las necesidades de los países en el monitoreo de sus programas de atención.

Se trata de una herramienta gratuita que permite, entre otras cosas, contar con información basada en evidencia para evaluar contextos sanitarios, evaluar y generar políticas, realizar investigaciones y tomar decisiones en favor de la vida, la salud y el desarrollo de mujeres y recién nacidos. Su validación es el resultado de un largo proceso de adopción y uso mantenido en cientos de instituciones. Más información en https://www.paho.org/es/sip

Perinatal Technologies