At Reverie Hotel, Time Square Saigon, On November 2019, I was speaking on a advisory session for CEO, IT Directors, CIOs, COO about the cyber security. There were around 20 - 25 CEO, CIO, COO, IT Directors ofdifferent companies were joining this session.


Why cyber security? because everyday almost 1+ million security threats are adding up to the pool of thrats to attack, share or take over our digital assets. This asset can be from our personal level to coporation level. I started with the very grass root level and then brough to the point which can let the audiences a set of bullet points which will help them to go back an start to work on them immediately for protecting their digital assets. The key line of prespective is here


The price is light is less than the price of darkness.

​Though this article I will share you the key bullets of that advisory session. I belive most of the reader know singhealth, this is a well named healthcare provider in Singapore. but since 2018 to now, it got serise of attacks and their information security failed to prevent/metigate those attacks and ended up lose hug amont of sensitive data, information. So now the situation of the singhealth user is like - most of the user cant take their laptop to home, have two laptops - one for office only and another they can take home, two phones etc. Required to spend signification amount of investment on information security aspect.

Their situation is like this picture. They were been in comfortable zone which did create different loop holes in their security system and finally due to multiple attacks they are in panic zone now.


This is a great lession learn. The companies who are in comfortable zone now, not paying attention, not developing their capabilities in information security space by learning, not investing the minimum amount, they will all end up at the panic zone and also will be forced to pay too high as well. Remember the quote?


The price is light is less than the price of darkness.

Cyber security is not something which you can just tick off a set of check list. It requies constent improvement in multimple dimention and that is only possible to building up a Cyber security culture in the organization. To build up the culture, there are the key elements pays the roles

• Process
  
• People
  
• Technology
  

Molding and farming of these three can create the right culture in an organization which can successfully tacket the cyber security issues of an organization. On this aspect the start point of views which I shared are




Process

• What’s your understanding of threat or cyber intelligence with respect to your organisation’s operating environment? •
  
• How does cyber threat intelligence play a differentiating in your organisation’s cyber security strategy? •
  
• Do you operate a SOC? Is it effective? What you can do to make that effective?
  
• How can it be further improved with the evolving threat landscape?
  

People

• Internal threats were cited as a big concern for many organisations, is this also an issue in your organisation?
  
• How do you mitigate risks associated with employees with poor cyber hygiene? • Is cyber security skill-set difficult to acquire? If yes, how are you currently addressing this within your organisation?
  
• Would you rather develop in-house capabilities or hire ready-made professionals with cyber expertise?
  
• Do you see a combination of both as part of your cyber security strategy?
  

Technology

• What sort of information do you need to put together a resilient cybersecurity strategy?
  
• What sort of cybersecurity tools are needed to implement your strategy? •
  
• From which channels do you procure threat intelligence? E.g. design own tools, subscribe to one or multiple cloud-based intelligence services provided by security Vendors/Managed Security Services?
  

​Most of the organization is far behind the cyber security capabilites so even many of them dont know they are already being compormised over and over. So I also share a key points where any organization should be starting assessing their cyber security status and then start their journey of building the defense macanism - 

 

Organizatoinal Culture: Assess and define the level of organizational culture. 

 

Business Stratigy and Scale: Clearly understand what is the business stratigy, focus in last 5 years and next 5 years, and also consider the scale of growth. 

 

Company Turn over: Assess and consider closely  the companity turn over rate, as it ties of organizational culture, security culture is a part of that

 

System Architecture: What is the present system landscape, their capacity, what is the % of legacy system, how well patched and what kind of security tool in place. 

 

These are the things actively they should not consider as well -

 

Previous assessment report: Dont accept those report, those may having very green but actualy true picture can be very different. So dont look at them and become bised. 

 

Financial Condition: Your financial condition is nothing to consider at the first stage of assessment, if you do you will lose the big picture. 

 

Incident report: It was not report, does not mean that did not happen. There is a number of organization did not even realize they were being hacked when their information was outside the market for months. So dont be happy by not seeing the insident reports. 

 

So let's pay attention to your information security. You can be in any role in the organization, CEO, CIO, Director, Manager or even a staff, you are part of the information security. Every digital asset you use in digital space in the company is the asset of the company andi t's your reponsibility to learn and keep the digital asset safe. 

 

Need help? Reach me any time!

John Masud Parvez
CIO, Organizational Transformer,
Founder and President of VSHR (Non profit)
More Details
https://www.health-revolution.org/about-john.html

​

Recently I wrote an article about, Healthcare 4.0 is not a myth anymore and it's happening now. There are 12 technology and Innovations are going to reshape the healthcare on 2020. Though my this article series I will give you a good understanding of each of this technology innovations and why they are reshape the healthcare on 2020. Let's call this series care2020 (#care2020) and this is the part 8. Previous was one was - This is starting with Walmart-ification of health care not uber -ification.


Let's start with this burning question -
Any Idea how many people are dying every year due to heart disease ?

In medical science the heart disease is call CVD (cardiovascular diseases). For this World Health Organization (WHO) did a survey world wide on 2016 cases and published a fast sheet, and here are the numbers -


An estimated 17.9 million people died from CVDs in 2016, representing 31% of all global deaths. Of these deaths, 85% are due to heart attack and stroke. Over three quarters of CVD deaths take place in low- and middle-income countries.
CVD is fatal! What do we see on those numbers? Too many people with suspected heart problems, invasive catheterization is necessary to diagnose blocked or narrowed arteries.


So how about the treatment? Doctors must choose the best method for improving blood flow from a handful of options, including balloon angioplasty and stenting.

Charles Taylor, a former Stanford professor, started HeartFlow to help patients avoid invasive diagnostic procedures and improve treatment outcomes. The company’s system creates personalized 3-D models that can be rotated and zoomed into, so doctors can simulate various approaches on screens. In some cases, it can help avoid invasive procedures entirely.
Duke University cardiologist Manesh Patel said-
“By adding the HeartFlow … to our available resources for diagnosing stable coronary disease, we are able to provide patients with better care as we evaluate risk,”.Well, this needs to be more tested and already there are POC happened and going to happen more. That means what we used to see in science fiction movie in even 5 years ago, are going to happen real soon, most likely by 2020. That's why I picked this technology innovation which is going to reshape the healthcare on 2020.

The next article is on 6th technology and innovation, will reshape the healthcare in 2020 - Rehab in virtual reality and maximize the time
Author

​

​John Masud Parvez
CIO, Organizational Transformer,
Founder and President of VSHR (Non profit)
More Details
https://www.health-revolution.org/about-john.html

Recently I was having a webinar mentoring session with my students. We talked about purpose in our life. I was discussing about an import aspect which I clarified on that discussion about -


Positive impact vs popularity, where should be the focus?

When I share or speak on any particular topics, the very first and foremost important thing for me is - What I am speaking is

• Got to be right at least in my prespective/experiance and that is is going to truly help the listener and
  
• Those are going to add value for those people’s life.
  

On the internet there are a lot of influencers, they're doing a lot of fun stuff, making a lot of jokes entertainment things, making people laugh, giving them a lot of fun advice example - The short cut to be rich, how to get a job quickly, how to nail down an interview etc


I don't do that because I don't think that's going to add true values for the listeners. For me I think that what actually help people

• become successful in life,
  
• develop their skillset,
  
• or improve mindset
  
• or have them to successful to achieving goals,
  
  
  I want to do it and that's the part I always only talk about.
  
  
  I completely understand that I am less popular than what I could be or even should be, but I'm perfectly happy with this. Why? because at the end of the day what I'm doing and my purpose is to help people into the life and and help them achieve their goals in life. And exactly that is what makes me happy.
  
  
  To me, I think my very first and foremost important thing is to speak and do, what is right, what is good for them.
  So yes some of my talk is not funny, not entertaining but focus on helping people achieve their goals. And I will never stop that, I will keep giving anything perspective, skillset, mindset, idea which can help other people.
  
  Let me grab an example - This line is very popular among young people, millennials -
  
  
  Do the things you love!
  
  That line sounds amazing but let me break it down to you, what you love is great for the thing when it's something like your hobby or you want to do it outside of your main work stream as something like your side stream. Then most of the case it will be perfect. But you want to make your living on that thing on that that could be a very different story.
  When you want to achieve something in your life you really need to learn many things even if you don't like or even don't love too because the thing what you only love that will not be always enough to help you become successful in your career, build a business.
  

o achieve goals, you will need to learn many other skill set and and many of them maybe you might like to do but some others you will not like to learn or even hate to learn. But you have to do because those skillsets are important why? Because those are going to help you to meet your purpose, your goals.


I will give you an example from my own life, I hated statistics subject when I was in high school but when I was studying science and engineering, I had to learn this program because I knew that this is going to be one of the key things for my any algorithm or even programing logics.


Let’s pick up another example - Few years ago, I did not like writing, so I was just giving speeches and that's it. But then I figured out that I have to write to communicate to more audiences. Because every person simply doesn't have the same English language competency, as I'm trying to communicate with them by English only.


That's why I write articles, I am writing books, journals, booklets to communicate with all of you.

So the bottom line is only doing the things, what we love is not enough to make us successful. To achieve goals or what you want to achieve in a career or a business or in our life so we need to learn, look for actively knowledge, opportunities, good intents etc to embrace them. It does not matter, those we really like or not.
We can't just throw away something which is needed because we don't like them.

Author
John Masud Parvez
CIO, Organizational Transformer,
Founder and President of VSHR (Non Profit Organization)
More Details
https://www.health-revolution.org/about-john.html

John Masud Parvez was keynote speaker to Asia IOT business platform on – Why and How to start a digital transformation for your companies. The Conference was organized at REX Hotel, Ho Chi Minh. And there were around 450+ Public sector government officials business leaders, CEO, Directors and entrepreneurs attending this conference. Though this article we will share you the summery of John Masud Parvez’s keynote speech.

​John Masud Parvez started with –

Dear Industry Leaders, Friends and Fellow mates ,

Transformation, Digital technology adaptation and utilization is becoming a KEY for every business sector. I am not here to sell you anything, no product. I am here to tell you, what is the thing can make your business, initiative more successful, your organization to achieve bigger goals. Why I am doing this? The only thing I want is you will think one day, You meet a guy John Masud Parvez in IOT Business platform and he helped you to open up your mindset to achieve bigger goals by leveraging the Digital Technology and transformation approaches.
So next 20 minutes, I am going to really PUSH you, with all my energy, and tell you please understand this, take this opportunity, go for growth and achieve bigger goals, or others will do, and they will simply knock you out of the picture in next maximum 5 years period of time.


What is your data? How are you looking at data on 2019?
For most of you are seeing data as your liability now. But let’s take a minute, people also hacking your data, collecting your data with IOT devices with or without your permission, do you ever think why? Why hackers want your data? Did you ever think why your tech company wants to take your data, want to keep your data?

Why my dear friend? Because data is your Asset. 

You simple did not realize the value of this new dominant currency and not did not able to put the perspective on that and see that as asset. You also did not transform your organization to establish a model where your data is your asset.
Though this is 2019, which is the prime time to grow, scale up the business and improve the service quality to serve the customer better, grow the customer base bigger but very little company actually perform the digital transformation Vietnam. Currently there are the almost like the 90% of the companies who are not performing the digital upshift due to the following two

1. They don’t know or did not realize the future business growth and very happy with their present portfolio of customer
   
2. They simply do not have the capability to perform a digital up shift.
   

This is very simple to justify why and how they are falling behind of the small percentages of companies who are actually performing the digital transformation to leverage the digital technology to scale up their business from now to next one to five year roadmap. Now let’s look at the other part of companies who are the memories, the present structure

• Most of the companies just has a IT Manager, Not even IT Director and CIO is an alien term for them
  
• Large part of the company CEO expressing himself as a CIO as well. So how is the CEO and who is the CIO? Simple the job is not done!
  
• To perform a transformation someone needs to lead or facilitate that, who is mainly Chief Transformation Office, This position is available in companies, which we could count by our hand’s figure.
  
  
  Now let’s talk about the minority who actually took the step forward and performing digital transformation by milestone. Just to ensure we are in the same page, I am not talking about implementing some IT system or software, I am talking about performing a organizational level transformation driven by data, technology and culture. We were running discussion in different level of those organizations internally and externally, but these companies misery is
  40% to 90% of those companies fall in the situation are as following –
  
• Could not perform their mission
  
• Delayed their goals
  
• Actually, the number is so high actually; they are passively demotivating the other organization to adopting the digital technology and perform organization level transformation. The key learning from them is the main reasons those companies struggles are:
  
• They started the transformation without really setting up their correct goals.
  
• They did not get the buy in from the C level and leadership team members. Just enforced that.
  
• They started the transformation without their internal capability, particularly their IT team’s capability
  
• They did not setup the right structure of the organization to facilitate the transformation
  
• They did not have expert and right consultants who were in the organization’s team side. So the tech companies highly skilled consultants directly worked with companies C level team (who has no idea about transformation journey) always got the deal done in their favor.
  
• Paid way over than they should.
  
  
  Those are the key learning from their fallout and over paying case studies. So let’s use those case as learning point and leverage those to perform your own organization’s transformation journey. This is 2020 starting with an amazing amount of opportunity go scale up your business, so let’s focus to leverage those by setting up your company’s culture, internal capability and right goals. One last point
  
  
  Digital Transformation is not about increasing or doubling the revenue, it’s such a small goals. Your goal should be much bigger than that, than you can even reach more than 2X revenue.
  
  
  On the closing mark John Masud Parvez finished with -
  
  
  Dear leaders, friends and industry fellows,
  I am finishing here today. There insight and approach I have shared you today and I am sure in next 2 – 3 years of time we will meet again, and here are the only possible scenraios
  
  Scenario 1: You actually listened to me today and go back and implement those notes which I took from my speech. And you will say ‘Thank you” your advices gave us a dimension to move forward on transformation.
  Scenario 2: You listened, you went back to your business and still did not took the initiative for your business in term of transformation. Which was your fundamental duty as business owner, Leader of the business. And you will be sharing your regrets with me.
  
  
  See you again! All the best! Thank you very much!
  
  
  To know more about John masud Parvez, Please visit here
  https://www.health-revolution.org/about-john.html
  

Does HD matter?: There is a lot of people think there only very high quality video files or HD views can get a lot of high attention. Actually this is not entirely true and not even close to true. If you pay attention around you, even in fb, you will there are many viral videos which are even pretty low quality, taken by phone, poor hand shaking but still got viral. Why ? Because that video has topic and agenda which matters to the people! People are interested in that topic! So the tips is focus on the the perspective which matters to the people. Example - In Vietnam's Amazing Student contest you are working a Nutrition project. Mentioned about the surprising problems which stock people, perspective which people want to hear, then you will see a lot of people will want to see your complete video. ​

Add key message or question: Second point is there are many videos which does not have any key message! When you are making a video add a key message in to that video or even better you ask a strong questions to the viewers and tell them to answer them of that questions by commenting the video. ​

Reach by sharing: Reaching and sharing is a very important point. You post in your facebook profile, and then also Target around 30 - 50 facebook groups around facebook, and share by your video to all those groups. Make sure your video setup as PUBLIC, so anybody can easily an see your video.


You can also share in VSHR Social Hub, a gacebook groupd, it's a student community of VSHR.

Target your audiences: Targeting the audience is another important point. So you try to share your video the viewers who are related to your topics. For example - in your video If you are talking hygiene for kids, then share your video to the people who are mom or parents. So you also target the groups where are for moms. If you video talking about Nutrition, then share your videos where there is a lot of young people and office worker, as they are interested about nutrition. ​

​These are the top video making tips today. Soon I will back with more tips. If you have question or need suggestion, feel free to contact us!

Recently I was having a webinar mentoring session with my students. We talked about purpose in our life. I was discussing about an import aspect which I clarified on that discussion about -

Positive impact vs popularity, where should be the focus?
When I share or speak on any particular topics, the very first and foremost important thing for me is - What I am speaking is

• Got to be right at least in my prespective/experiance and that is is going to truly help the listener and
• Those are going to add value for those people’s life.

On the internet there are a lot of influencers, they're doing a lot of fun stuff, making a lot of jokes entertainment things, making people laugh, giving them a lot of fun advice example - The short cut to be rich, how to get a job quickly, how to nail down an interview etc

I don't do that because I don't think that's going to add true values for the listeners. For me I think that what actually help people

• become successful in life,
• develop their skillset,
• or improve mindset
• or have them to successful to achieving goals,

I want to do it and that's the part I always only talk about.

I completely understand that I am less popular than what I could be or even should be, but I'm perfectly happy with this. Why? because at the end of the day what I'm doing and my purpose is to help people into the life and and help them achieve their goals in life. And exactly that is what makes me happy.

To me, I think my very first and foremost important thing is to speak and do, what is right, what is good for them.
​
So yes some of my talk is not funny, not entertaining but focus on helping people achieve their goals. And I will never stop that, I will keep giving anything perspective, skillset, mindset, idea which can help other people.

Let me grab an example - This line is very popular among young people, millennials -


Do the things you love!

That line sounds amazing but let me break it down to you, what you love is great for the thing when it's something like your hobby or you want to do it outside of your main work stream as something like your side stream. Then most of the case it will be perfect. But you want to make your living on that thing on that that could be a very different story.
When you want to achieve something in your life you really need to learn many things even if you don't like or even don't love too because the thing what you only love that will not be always enough to help you become successful in your career, build a business.

To achieve goals, you will need to learn many other skill set and and many of them maybe you might like to do but some others you will not like to learn or even hate to learn. But you have to do because those skillsets are important why? Because those are going to help you to meet your purpose, your goals.

I will give you an example from my own life, I hated statistics subject when I was in high school but when I was studying science and engineering, I had to learn this program because I knew that this is going to be one of the key things for my any algorithm or even programing logics.

Let’s pick up another example - Few years ago, I did not like writing, so I was just giving speeches and that's it. But then I figured out that I have to write to communicate to more audiences. Because every person simply doesn't have the same English language competency, as I'm trying to communicate with them by English only.

That's why I write articles, I am writing books, journals, booklets to communicate with all of you.
​So the bottom line is only doing the things, what we love is not enough to make us successful. To achieve goals or what you want to achieve in a career or a business or in our life so we need to learn, look for actively knowledge, opportunities, good intents etc to embrace them. It does not matter, those we really like or not.

We can't just throw away something which is needed because we don't like them.

At Reverie hotel, Time Square Saigon, On November 2019, John Masud Parvez was speaking on a advisory session for COOs, IT Directors and CEOs about the cyber security. There were around 20 - 25 IT Directors, CIO, CEOs, COOs of different companies were joining this session.  Though this article we will share you the key notes of that advisory session. John Masud Parvez was saying - 

Why cyber security? because everyday almost 1+ million security threats are adding up to the pool of thrats to attack or take over our digital assets. This asset can be from our personal level to coporation level. I started with the very grass root level and then brough to the point which can let the audiences a set of bullet points which will help them to go back an start to work on them immediately for protecting their digital assets. The key line of prespective is here

The price is light is less than the price of darkness.

Their situation is like this picture. They were been in comfortable zone which did create different loop holes in their security system and finally due to attack they are in panic zone now.

This is a great lession learn. The companies who are in comfortable zone now, not paying attention, not developing their capabilities in information security space by learning, not investing the minimum amount, they will all end up at the panic zone and also will be forced to pay too high as well. Remember the quote?

The price is light is less than the price of darkness.

Cyber security is not something which you can just tick off a set of check list. It requies constent improvement in multimple dimention and that is only possible to building up a Cyber security culture in the organization. To build up the culture, there are the key elements pays the roles

• Process
  
• People
  
• Technology
  

Molding and farming of these three can create the right culture in an organization which can successfully tacket the cyber security issues of an organization. On this aspect the start point of are

Process

• What’s your understanding of threat or cyber intelligence with respect to your organisation’s operating environment? •
  
• How does cyber threat intelligence play a differentiating in your organisation’s cyber security strategy? •
  
• Do you operate a SOC? Is it effective? What you can do to make that effective?
  
• How can it be further improved with the evolving threat landscape?
  

People

• Internal threats were cited as a big concern for many organisations, is this also an issue in your organisation?
  
• How do you mitigate risks associated with employees with poor cyber hygiene? • Is cyber security skill-set difficult to acquire? If yes, how are you currently addressing this within your organisation?
  
• Would you rather develop in-house capabilities or hire ready-made professionals with cyber expertise?
  
• Do you see a combination of both as part of your cyber security strategy?
  

Technology

• What sort of information do you need to put together a resilient cybersecurity strategy?
  
• What sort of cybersecurity tools are needed to implement your strategy? •
  
• From which channels do you procure threat intelligence? E.g. design own tools, subscribe to one or multiple cloud-based intelligence services provided by security Vendors/Managed Security Services?
  

Most of the organization is far behind the cyber security capabilites so even many of them dont know they are already being compormised over and over. So I also share a key points where any organization should be starting assessing their cyber security status and then start their journey of building the defense macanism -

• Organizatoinal Culture: Assess and define the level of organizational culture.

 

• Business Stratigy and Scale: Clearly understand what is the business stratigy, focus in last 5 years and next 5 years, and also consider the scale of growth.

 

• Company Turn over: Assess and consider closely the companity turn over rate, as it ties of organizational culture, security culture is a part of that

 

• System Architecture: What is the present system landscape, their capacity, what is the % of legacy system, how well patched and what kind of security tool in place.

These are the things actively they should not consider as well -

Previous assessment report: Dont accept those report, those may having very green but actualy true picture can be very different. So dont look at them and become bised.

Financial Condition: Your financial condition is nothing to consider at the first stage of assessment, if you do you will lose the big picture.

Incident report: It was not report, does not mean that did not happen. There is a number of organization did not even realize they were being hacked when their information was outside the market for months. So dont be happy by not seeing the insident reports.

So let's pay attention to your information security. You can be in any role in the organization, CEO, CIO, Director, Manager or even a staff, you are part of the information security. Every digital asset you use in digital space in the company is the asset of the company andi t's your reponsibility to learn and keep the digital asset safe.

​Overview
Cesarean delivery is defined as the delivery of a fetus through surgical incisions made through the abdominal wall (laparotomy) and the uterine wall (hysterotomy).
In 2014, 32.2% of women who gave birth in the United States did so by cesarean delivery. The rapid increase in cesarean birth rates from 1996 to 2014 without clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. [1]
Indications
Cesarean deliveries were initially performed to separate the mother and the fetus in an attempt to save the fetus of a moribund patient. They subsequently developed to resolve maternal or fetal complications not amenable to vaginal delivery, either for mechanical limitations or to temporize delivery for maternal or fetal benefit. The leading indications for cesarean delivery (85%) are previous cesarean delivery, breech presentation, dystocia, and fetal distress.
Maternal indications for cesarean delivery include the following:

• Repeat cesarean delivery
• Obstructive lesions in the lower genital tract, including malignancies, large vulvovaginal condylomas, obstructive vaginal septa, and leiomyomas of the lower uterine segment that interfere with engagement of the fetal head
• Pelvic abnormalities that preclude engagement or interfere with descent of the fetal presentation in labor  ​
• Certain cardiac conditions that preclude normal valsalva done by patients during a vaginal delivery . [1]

 
Fetal indications for cesarean delivery include the following:

• Situations in which neonatal morbidity and mortality could be decreased by the prevention of trauma
• Malpresentations (eg, preterm breech presentations, non-frank breech term fetuses)
• Certain congenital malformations or skeletal disorders
• Infection
• Prolonged academia [1]

 
 

​Indications for cesarean delivery that benefit the mother and the fetus include the following:

• Abnormal placentation (eg, placenta previa, placenta accreta)
• Abnormal labor due to cephalopelvic disproportion
• Situations in which labor is contraindicated [1]

Contraindications
There are few contraindications to performing a cesarean delivery. In some circumstances, a cesarean delivery should be avoided, such as the following:

• When maternal status may be compromised (eg, mother has severe pulmonary disease)
• If the fetus has a known karyotypic abnormality or known congenital anomaly that may lead to death (anencephaly) [1]

Complications

• Approximately 2-fold increase in maternal mortality and morbidity with cesarean delivery relative to a vaginal delivery Partly related to the procedure itself, and partly related to conditions that may have led to needing to perform a cesarean delivery
• Infection (eg, postpartum endomyometritis, fascial dehiscence, wound, urinary tract)
• Thromboembolic disease (eg, deep venous thrombosis, septic pelvic thrombophlebitis)
• Anesthetic complications
• Surgical injury (eg, uterine lacerations; bladder, bowel, ureteral injuries)
• Uterine atony
• Delayed return of bowel function [2]

 
ACOG/SMFM guidelines for prevention of primary cesarean delivery
The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) released joint guidelines for the safe prevention of primary cesarean delivery. These include the following :

• Prolonged latent (early)-phase labor should be permitted
• The start of active-phase labor can be defined as cervical dilation of 6 cm, rather than 4 cm
• In the active phase, more time should be permitted for labor to progress
• Multiparous women should be allowed to push for 2 or more hours and primiparous women for 3 or more hours; pushing may be allowed to continue for even longer periods in some cases, as when epidural anesthesia is administered
• Techniques to aid vaginal delivery, such as the use of forceps, should be employed
• Patients should be encouraged to avoid excessive weight gain during pregnancy

​

• Access to nonmedical interventions during labor, such as continuous support during labor and delivery, should be increased
• External cephalic version should be performed for breech presentation
• Women with twin gestations should, if the first twin is in cephalic presentation, be permitted a trial of labor [2]

Adjunctive Azithromycin Prophylaxis for Cesarean Delivery
The addition of azithromycin to standard regimens for antibiotic prophylaxis before cesarean delivery may further reduce the rate of postoperative infection. We evaluated the benefits and safety of azithromycin-based extended-spectrum prophylaxis in women undergoing nonelective cesarean section. [2]
 
ConclusionReducing caesarean delivery rates in Mexico will require more than public awareness, guidelines and policies. First, an improved data collection and quality assurance system is necessary to better understand the consequences of high caesarean delivery rates over time. Second, increased oversight and regulation of private insurance companies is needed to reverse the perverse economic incentives that contribute to a very high caesarean delivery rate in the private sector. Finally, the medical and public health community must take an active role in educating the next generation of obstetricians and gynaecologists, the public and the insurance industry on the well documented benefits of vaginal delivery for both women and their newborns. Multilevel interventions, such as those available to improve quality of care for member countries of the Organization for Economic Co-operation and Development, 26 are urgently needed to safely reduce the high rate of caesarean delivery in Mexico, particularly in private-sector hospitals. [2]
 
References:
 

1. https://emedicine.medscape.com/article/263424-overview
2. https://www.who.int/bulletin/volumes/85/10/06-035808/en/

​

Author details 
Shadat Nabil
Student,Department of Pharmaceutical science, North South University.