‘The value of volunteerism’:FIGO President encouragesglobal action in 2014

In ternat iona l Federat ion of Gynecology and Obstet r ics | December 2013 1

Success of FIGO’s first Africa Regional Conference in Addis Ababa | Spotlight on The Global Libraryof Women’s Medicine | NESOG revamps its communications strategy | Indonesian and Ugandan

workshops set the scene for new FIGO-ICM-IPA ‘Essential Interventions’ project

continued on page 2

International Federation ofGynecology and ObstetricsFFIIGGOOFIGO

INSIDE:

communications@figo.orgwww.figo.org December 2013

Dear ColleaguesWe are living in a world of economic,environmental and civic turmoil. Women andchildren are particularly vulnerable at such times,and require extra specialist help and support.FIGO offers condolences to those affected – eventhough our resources are naturally limited, weurge those who can to help in any way they can.

The challenges of NCDs, ClimateChange and HealthAs well as natural catastrophes, there are twosilent ‘cyclones’ or ‘tsunamis’ that willundoubtedly affect current and futuregenerations: non-communicable diseases (NCDs)and climate change and health. FIGO is workingwith the World Diabetes Foundation (WDF) andregional and national societies to look at theissue of the diabetic and obesity epidemics. Ouraim is to halt them through influencing

adolescent and young women’s nutrition so thatthe epigenetic influences of foetal origins of adultdisease can be curtailed to some degree.Recently, FIGO and WDF held well-receivedworkshops on these important topics atconferences in Addis Ababa, Mexico andShanghai, with the assistance of Professor LuisCabero-Roura, Professor Moshe Hod, Dr AnilKapur (former WDF Managing Director) and DrAnders Dejgaard (current WDF ManagingDirector).

A human rights-based approachIn my capacity as President of the British MedicalAssociation (BMA) I am working – with itsvaluable help – on the issues of NCDs, climatechange and health, to help increase volunteerismby doctors and training students from all UKmedical schools on a human rights-basedapproach to women’s health. Professor LesleyRegan, Chair of the FIGO Committee for

Women’s Sexual and Reproductive Rights(WSRR), is spearheading this particular initiative –for example, FIGO held a very successfulworkshop on this topic, with Dr Diane Magrane(Committee Co-chair) and Professor Pak ChungHo (Committee member), at the recent Asian &Oceanic Congress of Obstetrics andGynaecology.

I would therefore make a plea to nationalsocieties, and individuals, to be active in theseareas via voluntary activity to help those in need,as well as teaching and training in a rights-basedapproach to care. Further information can befound at: www.glowm.com/womens_health_rights.

The urgent need for contraceptionWomen in this world are dying because of a lackof contraception. It is estimated that there could

L–R: Ms Miriam Maluwa, UNAIDS Senior Adviser, Policy & Programmes; Professor Sir Sabaratnam Arulkumaran, FIGO President; Dr Luiz Loures, UNAIDS Deputy Executive Director,Programme; Professor CN Purandare, FIGO President Elect; Professor Hamid Rushwan, FIGO Chief Executive; Dr Hani W Fawzi, Chair of Scientific Committee; Ms Rosemary Museminali,UNAIDS Representative to the AU and UNECA; Mr Warren Naamara, UNAIDS Country Coordinator for Ethiopia (FIGO Africa Regional Conference, Addis Ababa, October 2013)

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‘The value of volunteerism’: FIGO President encourages global action in 2014continued from page 1

In ternat iona l Federat ion of Gynecology and Obstet r ics | December 20132

be a 30 per cent reduction in maternal deaths byexpanding contraceptive services. Many multi-donor agencies are working in this area but morehelp is needed, especially through professionalsocieties, so FIGO is keen to engage withsocieties to see how matters can be improved.FIGO’s new project in this area – ‘InstitutionalisingPost-Partum Intrauterine Device (IUD) Servicesand Increasing Access to Information andEducation on Contraception and Safe AbortionServices’ – is underway, with many activitiesplanned. As background, in several countriesyoung women undergo tubal occlusion becauseof the unavailability of other methods ofcontraception. Long acting reversiblecontraceptives (LARCs) with IUD or implants maybe suitable alternatives, and the best time toaction this for many women may be immediatepost-delivery – after women leave hospital afterbirth, they may encounter difficulties in returningto health facilities to receive suitablecontraceptive advice.

I also attended an important meeting inSeptember in the UK on this subject, facilitatedby the Population Council and the LondonSchool of Hygiene & Tropical Medicine. This mayindeed be an opportune time for nationalsocieties and regional federations to plan howbest they can work with government, NGOs anddonors to improve the contraceptive situation intheir own countries.

Professor Sir Sabaratnam Arulkumaran, FIGO President,addressing the first FIGO African Regional Conference(Addis Ababa, October 2013)

FIGO presence at high-profilenational and regional meetingsAs FIGO President, I attended the excellentFOGSI Southern Zone, Tamil Nadu meeting inAugust, with special sessions devoted to schoolchildren and the public. Shortly afterwards, thePresident of the Royal Australian and NewZealand College of Obstetricians andGynaecologists, Professor Michael Permezel,invited me to attend its excellent annual meeting,where evidence-based medicine and guidelineswere robustly challenged in every session.

Following this, the FOGSI-FIGO ‘InternationalConference on Recent Advances in Obstetricsand Gynecology’, organised by the energeticProfessor Shantha Kumari, was held inHyderabad, India, in late September. There was arecord attendance of over 1,000 participants andthe scientific programme was enhanced with anumber of excellent pre-congress workshops.Attending the Singaporean and Swedishsocieties’ meetings also enriched my knowledge- they, too, are trying to see how best they caninteract and help less well-resourced countries.

Most high-profile of all recent meetings was thefirst FIGO Africa Conference of Gynecology andObstetrics, held in early October in Addis Ababa,Ethiopia, expertly presided over by ConferencePresident Dr Yirgu Gebrehiwot (also President ofthe African Federation of Obstetrics andGynaecology; AFOG). The Conference attractedan attendance of over 800 delegates from 70countries, and the scientific programme, ably

overseen by Chair Dr Hani Fawzi, was excellent.We also met with the Ministers of Health andForeign Affairs who pledged their full support forAFOG and FIGO activities in general.

All those involved inpreparations for thisground-breakingregional conferencedeserve our sincerethanks. We hope therewill be more interactionbetween Africannational societies to

help improve women’s health on this greatcontinent.

One African highlight was a visit to the HamlinFistula Hospital in Addis Ababa(www.hamlinfistula.org) – an amazingorganisation. Dr Catherine Hamlin and her staffdeserve every recognition for the outstandingwork they have performed over severaldecades. FIGO is proud to be associatedwith Catherine and the hospital – it is nowthe main training centre for FIGO Fellows.

In mid-October, I attended – together withProfessor Rushwan - the World Congressof Surgery, Obstetrics, Trauma andAnesthesia (WCSOTA) in Trinidad andTobago, supported by several prestigiousorganisations, including Johns HopkinsUniversity School of Medicine, theInternational College of Surgeons, theWorld Federation of Societies ofAnaesthesiologists, and the Ministry ofHealth of Trinidad. Special thanks go toProfessor Jean Anderson from JohnsHopkins and Professor Samuel Ramsewak,Dean of Medical Sciences at the Universityof the West Indies, for enabling ourparticipation at this superb event.

In late October I attended the 64th CongresoMexicano de Ginecología y Obstetricia, inMexico, participating both in the pre-congressworkshop sponsored by WDF and in the mainconference. My congress plenary focused on‘Knowledge Transfer’, and incorporated amention of The Global Library of Women’sMedicine (www.glowm.com), the educationalplatform supported by FIGO (see page four for aninterview with David Bloomer, its founder). I waspleased to be given the chance to promote theexcellence of the GLOWM website, and to beable to give an indication of its breadth: eghundreds of ultrasound pictures; tens of videosand master class lectures; and hundreds of text-book chapters, etc. Professor Ernesto Castelazo,FIGO’s Vice President, and his team, looked afterus well – we owe congratulations to Ernesto onhis being elected the new President of theMexican national federation.

After Mexico, I visited Cordoba with ProfessorLuis Cabero-Roura to attend the conference ofthe Argentinian Federation, superbly overseen byits President (and FIGO Executive Boardmember) Professor Néstor Garello. Simultaneoustranslation enabled full participation by theaudience. Professor Luis Cabero-Roura and Iwere honoured to receive recognition fromCordoba University (one of the oldest universitiesin the world) – a doctorate and professorshiprespectively. We were delighted and grateful fortheir kind gesture. More importantly, this gave usan opportunity to meet with seven FIGOExecutive Board members and members of theFederation of Latin American Societies ofGynecology and Obstetrics (FLASOG) to discussmatters of mutual interest and concern.

In November I participated in the InternationalAnnual Meeting of the Lebanese Society ofObstetrics and Gynecology. The theme,

‘Integrated Care in Acute Emergencies’, wascertainly an appropriate focus with regard to theircurrent situation. Lebanon’s population is 4.2million – already there are more than a millionrefugees arriving from Syria and they areexpecting a further million. They are planning howbest to deal with the health needs of women andchildren. FIGO Executive Board member, andCo-ordinator of the Congress, Professor FaysalEl-Kak, is working closely with the Lebanesenational society, and is partially seconded to theMinistry of Public Health. FIGO encourageseveryone involved to give of their best, and welook forward to learning from their experiences infuture meetings.

One observation I would make is that our hostsare all busy with their clinical practices, teachingand research, but yet give us time and look afterus well – splendid hospitality for which I and myfellow colleagues are most grateful.

Countdown to Vancouver 2015:preparations in full swing

The preparation for thenext FIGO WorldCongress in Vancouver(4–9 October 2015) iswell in hand, under theleadership of ourvarious CongressCommittees. Theconference facilitiesare second to none,and the hotelaccommodationexceptionally wellappointed, and allwell within walkingdistance. TheCongress ‘FirstAnnouncement’ hasnow been released

(see www.figo2015.org andwww.figo.org), so I urge you to reserve thedates and join us for what will be a trulymemorable event. I have no doubt it will be agreat success and I want you, FIGO’s valuedcolleagues, to play an integral part in thatsuccess.

The tool of advocacy:Recognising and supportingglobal days of interestAs a final word, I would like to stress thatadvocacy as a tool has never been moreimportant. Our standard practice (alongside otherorganisations) is to issue statements of supporton important global days – for example, WorldPrematurity Day – to help galvanise organisationsto work together. Ms Alexandra Gilpin, ourCommunications Officer, together with the FIGOleadership, produces these statements, andposts them on www.figo.org. We now emailthese important messages to national societiesfor them to disseminate and to encourage themto produce their own.

FIGO and I are most grateful to all of you forimproving the health of women both asindividuals, and through your respectiveorganisations. I would like to take this opportunityto thank you for the tremendous support that youprovide. I would also like to thank the hard-working FIGO staff for their efforts. This finalNewsletter of 2013 comes to you with our verybest wishes for a ‘Happy New Year’, and apositive beginning to 2014!

With kind regards

Professor Sir Sabaratnam ArulkumaranFIGO President

PRESIDENT’S MESSAGE

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CHIEF EXECUTIVE’S OVERVIEW

In ternat iona l Federat ion of Gynecology and Obstet r ics | December 2013 3

FIGO HouseWaterloo Court, 10 Theed StreetLondon SE1 8ST, UKTel: +44 20 7928 1166Fax: +44 20 7928 7099Email: figo@figo.org

The International Federation of Gynecology andObstetrics is a UK Registered Charity (No 1113263;Company No 5498067) registered in England andWales. The Registered Office is shown above.

President:Professor Sir Sabaratnam Arulkumaran(United Kingdom)

President-Elect:Professor Chittaranjan Narahari Purandare (India)

Past-President:Professor Gamal Serour (Egypt)

Vice President:Professor Ernesto Castelazo Morales (Mexico)

Honorary Secretary:Professor Gian Carlo Di Renzo (Italy)

Honorary Treasurer:Professor Wolfgang Holzgreve (Switzerland)

Chief Executive:Professor Hamid Rushwan (Sudan/UK) (Ex-offico)

Administrative Director:Bryan Thomas

Readers are invited to send items for consideration (byemail to communications@figo.org or on disk) to theFIGO Secretariat no later than 1 March 2014 for thenext issue.

The views expressed in articles in the FIGO Newsletterare those of the authors and do not necessarily reflectthe official viewpoint of FIGO.

Produced and edited by Alexandra Gilpin at the FIGOSecretariat © FIGO 2013.

International Federation of Gynecology and Obstetrics

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Dear ColleaguesFIGO’s global activities continue apace until thevery end of 2013 and beyond, and the last fewmonths have witnessed great regional andinternational developments.

Green light for ‘EssentialInterventions’ WorkshopsSeptember brought the new FIGO project for‘Improving the Quality of Maternal and NewbornHealthcare Services Through AcceleratedImplementation of the Essential Interventions bythe Healthcare Professionals’ Associations’ intosharp focus, as two inception workshops wereheld in Jakarta, Indonesia, and Kampala,Uganda, respectively (see page six). Much wasachieved at these valuable meetings, and welook forward to progressing the project over thenext few months.

In mid-September, FIGO participated effectively inthe scientific programme at the FOGSI-FIGOInternational Conference on ‘Recent Advances inObstetrics & Gynaecology’, Hyderabad, India.The conference was exceptionally well attended,offering a rich and varied programme, and itnaturally gave me the valuable opportunity ofmeeting with many of our FOGSI counterparts.The meeting demonstrated the importance ofFIGO collaboration with national and regionalassociations in conducting high qualityconferences.

Professor Rushwan at the first FIGO Africa RegionalConference, Addis Ababa, October 2013

It gives me great pleasure to report that the firstFIGO Africa Regional Conference held in AddisAbaba in October was a tremendous success.Attracting over 800 delegates from nearly 70countries, the conference was truly aninternational event, as well as welcoming thecream of Africa’s ob-gyn community. A number ofstakeholders participated – the Ethiopian Societyof Obstetricians and Gynecologists (ESOG)provided excellent support and high-level officialsparticipated in the opening and closingceremonies. The African Federation of Obstetricsand Gynaecology (AFOG) also made use of theopportunity to hold its Annual General Meeting,and discussed strategies for advancing its work.

During the conference, a visit was made to theHamlin Fistula Hospital in Addis Ababa(www.hamlinfistula.org) which is now the maintraining centre for FIGO Fellows. Dr CatherineHamlin was met during the visit, and all presentexpressed admiration for the excellent workbeing performed in the institution to help womenin great need.

The FIGO leadership and colleagues from the AfricanFederation of Obstetrics and Gynaecology (AFOG) meetDr Catherine Hamlin

Another important activity during the conferencewas the excellent FIGO master training course on‘Helping Mothers Survive Bleeding After Birth(HMS-BAB)’ – conducted in collaboration withJhpiego and the Laerdal Foundation – attendedby representatives from seven countries. Thecourse will provide the basis for the selection ofcountries for a new FIGO project, supported bythe Foundation.

‘Bleeding after Birth’ workshop – Professor Rushwancentre (at the FIGO Africa Regional Conference, October2013)

WCSOTA: Focus on surgical,obstetrical, trauma and anaesthesiacareIn mid-October, alongside the FIGO President, Iattended the World Congress of Surgery,Obstetrics, Trauma and Anesthesia (WCSOTA) inTrinidad and Tobago. This high profileconference, hosted by the International Collegeof Surgeons, the World Federation of Societies ofAnaesthesiologists, Johns Hopkins UniversitySchool of Medicine, and the Ministry of Health ofTrinidad, was an ideal platform from which toshare knowledge to advance surgical, obstetrical,trauma and anaesthesia care.

In late October, Iparticipated in animportant TechnicalWorking Groupmeeting: developmentof the ‘WHO Guidanceon implementing, andmeasuring, quality ofcare in midwiferyservices’, at WHO HQin Geneva. Topicsdiscussed includedreviewing the currentknowledge base onquality of care inmidwifery services, andidentifying knowledge

gaps. It was also agreed to develop abackground paper that will provide the basis ofthe ‘WHO guidance in implementing andmeasuring quality of care in midwifery services’.

In November, I participated in the 9th Conferenceof the Pacific Rim Society for Fertility and Sterility,Kobe, Japan – where FIGO was prominent in theScientific Programme – and the Japan Society forReproductive Medicine’s (JSRM) 55th meeting.The organisation of these meetings, and thetraditional Japanese hospitality, was, asexpected, outstanding.

In late November, I attended the 80th NestléNutrition Institute Workshop conference in Bali,Indonesia with Professor Purandare, FIGOPresident-Elect: ‘Health and Nutrition inAdolescents and Young Women: Preparing for theNext Generation’. This highly important Workshopspanned many crucial subject areas such asobesity, diabetes, the social determinants of healthin adolescents, and nutrition challenges in low-and middle-resource countries. FIGO isnegotiating with stakeholders to receive anunrestricted educational grant – its overallobjective is to produce, disseminate andimplement evidence-based guidelines on maternalnutrition, from pre-conception to the post-partumperiod, in collaboration with obstetricians andgynecologists and other key healthcareprofessionals and workers, thereby contributing tothe advancement of women’s reproductive healthand rights and the promotion of newborn andchild health. We look forward to working with themon this highly important enterprise.

FIGO presence at World InnovationSummit for HealthAs this goes to press, I am travelling to Doha asFIGO has been invited to attend the WorldInnovation Summit for Health – under thepatronage of Her Highness Sheikha Moza bintNasser – an international summit (last held inLondon, in 2012) with the objective of catalysingthe innovations needed ‘to meet modern healthchallenges such as the non-communicabledisease epidemic and achieving universal accessto healthcare’. It is a prestigious event, attractingmany figureheads, and I look forward to reportingon its conclusions in early 2014.

At the end of what has been a challenging butproductive year, I wish you and your families apeaceful start to 2014. There is much workahead of FIGO in its continuous quest to ensurethat every woman, wherever she lives in theworld, has her physical, mental, reproductive andsexual health needs met by a highly professionalstandard of healthcare.

Best wishes for 2014.

Professor Hamid RushwanFIGO Chief Executive

Professor Rushwan with DrLeslie Mancuso, Presidentand Chief Executive Officer,Jhpiego (WCSOTAconference, October 2013)

FIGO INITIATIVES …LOGIC

4

‘Enhancing communication with members’:A case study from the Nepal Society ofObstetricians & Gynaecologists (NESOG)– supported by the FIGO LOGIC Initiativeby Dr Pushpa Chaudhary, NESOG President

Communication isderived from the Latinword ‘communis’, thatmeans ‘to share’. It is atwo-way process andinvolves a meaningfulflow or exchange ofthoughts, messages,or information withinpeople or a group ofspeech, visuals,signals, writing orbehaviour.1 ‘Media’

means communication channels such astraditional broadcast media and mass media,as well as modern communication media,including telecommunication – media for long-distance communication.2

Professional associations can effectivelycontribute to people’s health status if they areempowered with better organisational capacityand leadership. FIGO supported the NepalSociety of Obstetricians & Gynaecologists(NESOG) to help them influence national healthpolicy and practice through FIGO’s Leadership inObstetrics and Gynecology for Impact andChange (LOGIC) Initiative in Maternal andNewborn Health. An Organisational CapacityImprovement Framework (OCIF), developed bythe Society of Obstetricians and Gynaecologistsof Canada (SOGC), was used to evaluate thebaseline organisational capacity developmentefforts.

NESOG’s early communicationsMembers are the strength of any organisationand better communication and linkage withmembers improves ‘belongingness’ to anorganisation and ultimately results in betterperformance of members and the organisation.Before the FIGO LOGIC project, communicationwas mostly interpersonal and telephonic, withvery limited use of electronic media, particularly

emails, until 2001. Major decisions were takenduring meetings such as Continuing MedicalEducation (CME) Workshops. Limited use ofgroup SMS was used by the President/Secretarythrough personal mobile phones. NESOGJournals and Newsletters were first launched in2005. During NESOG’s initial organisationalcapacity assessments in 2010, a tool to assessits operational capacity was rated as moderate(39 per cent).

Seizing the opportunitySeveral initiatives were taken to improvecommunication with members and to keep theminformed about NESOG activities. The office ‘setup’ was improved, with the addition of highspeed internet access. Activities included:sending group emails/messages to disseminateinformation regarding CME training workshopsand conferences, as well as sharing opportunitiesand resources; updating member profiles,including contact details; printing a newmembers’ list in the NESOG Newsletter; updatingFacebook and its photo gallery with recentactivities; and updating the NESOG website –www.nesog.org.np – with a new banner andmore information, including a member list, detailson affiliations with FIGO, AOFOG, SAFOG and

collaborative partners, and information onnational and international events, includingconferences, and achievements of NESOGmembers.

Participation of NESOG members in its variousactivities was strong, such as attendance atWorkshops on subjects including Grant ProposalWriting, Advocacy, Constitution Amendment andNear-Miss Reviews. NESOG CME conferencesoutside Kathmandu Valley were also increased.Members were impressively active inreciprocating via Facebook, and throughparticipation in online voting in the NESOGelections (84 per cent). There was also aremarkable increase in the number of newmembers.

Special challengesHowever, there were still a few barriers tocommunication, including ‘load shedding’ [powercuts] and slow internet connections. Due to theirbusy schedules, daytime telephoniccommunication with members was often difficult.Limited access to and reciprocation of emails,particularly among members outside KathmanduValley, as well as a low response to SMS, wasalso noticed, and there was no evidence that thewebsite was regularly accessed by the majority ofmembers. It was, however, noted that SMS andtelephonic communications were preferred.

Further refinementsAdditional efforts for effective communicationwere the formation of extended NESOGcommittees/sub-committees, and exploring sub-specialty training opportunities for members. Thewebsite was made even more dynamic with theaddition of a new banner, a members’ blog andgreater promotion of social media. Goingforward, communication will continue to be madeeven more effective, including teleconferencingand Skyping with members, which is particularlyuseful in supporting those working in remotedistricts.

ConclusionSuch interventions under the support of the FIGOLOGIC Initiative suggest that innovativeapproaches to enhanced communicationbetween members of a society, spread all overthe country, with diverse geography, can result ina positive impact on members’ participation in aprofessional association’s activities.References:1. http://en.wikipedia.org/wiki/Communication2. http://en.wikipedia.org/wiki/Media_(communication)

The FIGO LOGIC Initiative concluded at the end of October 2013

Dr Pushpa Chaudhary,NESOG President

NESOG organisational capacity assessment by the SOGC’s Liette Perron in 2010 (front row, right)

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FIGO Misoprostol Initiative:new resources available in Portuguese

Three new resources in Portuguese (outlining both prevention andtreatment of post-partum haemorrhage with misoprostol, anddetailing recommended dosages) are now available on the FIGOwebsite at: http://www.figo.org/projects/figo-misoprostol-post-partum-haemorrhage-low-resource-settings-initiative.French and Spanish versions are also available.

The Initiative has also been active in sharing the latest evidence at anumber of recent major conferences: the first FIGO Africa RegionalConference in Addis Ababa; the Brazilian Congress of Gynecologyand Obstetrics; and theAnnual Conference ofthe Lebanese Societyof Obstetrics andGynecology.

Upeka de Silva, theInitiative’s ProjectManager, said: ‘Theexpert panel sessions

and materials have been well received.In addition to sustaining these dissemination efforts,focus will also be placed on assessing the value of thisinitiative at national level in 2014.’

MISOPROSTOLDoses recomendadas 2012

800µg

600µg

400µg

200µg

100µg

25µg

Aborto induzido1

800µg pv ou sl a cada 3h

(máx x3 en 12h)a Tratamento da HPP800µg sl dose únicaf

Profilaxia da HPP2

600µg po dose únicae

Maduração cervical

pré-instrumentação400µg pv 3 h ou sl 2–3h

antes do procedimentoa

Aborto induzido1,4/

Interrupção da gravidez

400µg pv ou sl a cada 3h

(máx x5)a

Morte fetal intrauterina4

13–17 semanas200µg pv a cada 6h

(máx x4)c

Morte fetal intrauterina4

18–26 semanas100µg pv a cada 6h

(máx x4)c

Cuidado com cicatriz uterina prévia e com cesárea

Segundo Trimestre Terceiro Trimestre Pós-Parto

Primeiro Trimestre

Morte fetal intrauterina5

25µg pv a cada 6hou

25µg po a cada 2hd

Indução de parto2,5

25µg pv a cada 6hou

25µg po a cada 2hd

FFIIGGOOFIGO

Consulte atualizações em www.figo.org

Notas1 Para uso onde é legalizado, e com mifepristone, onde esteja disponível

2 Incluído na Lista Modelo de Medicamentos Essenciais da OMS

3 Esperar por 1–2 semanas para que tenha efeito, exceto em caso de

sangramento excessivo ou infecção

4 Reduzir as doses pela metade em caso de cesárea prévia ou outra cicatriz

uterina5 Assegurar-se de que utiliza a dose correta. Doses excessivas podem causar

complicações. Não use em caso de cesárea prévia

Referênciasa Abortamento seguro: orientação técnica e de políticas para sistemas de

saúde – 2ª ed.2013

b Gemzell-Danielsson et al. IJGO, 2007

c Gómez Ponce de León et al. IJGO, 2007

d Recomendações da OMS para indução do parto, 2011

e Diretrizes FIGO: Prevenção da HPP com misoprostol, 2012

f Diretrizes FIGO: Tratamento da HPP com misoprostol, 2012

Abreviaturas: pv via vaginal; sl via sublingual; po via oral; HPP hemorragia pós-parto; µg micrograma

Aborto retido800µg pv a cada 3h

(máx x2)ou

600µg sl a cada 3h(máx x2)b

Aborto incompleto2,3

600µg po dose únicaa

ou400µg sl dose únicaa

Tratamento deHemorragia Pós-Parto

com Misoprostol

D I R E T R I Z E S F I G OV E R S Ã O A N O T A D A

FIGOFIGO

Prevenção deHemorragia Pós-Partocom Misoprostol

D I R E T R I Z E S F I G OV E R S Ã O A N O T A D A

In ternat iona l Federat ion of Gynecology and Obstet r ics | December 2013

5In ternat iona l Federat ion of Gynecology and Obstet r ics | December 2013

FIGO INITIATIVES …ESSENTIAL INTERVENTIONS

Green light for Jakarta and Kampala‘Essential Interventions’ InceptionWorkshops

FIGO collaborates on ‘Helping Mothers Survive Bleeding After Birth’In 2013, FIGO secured funding from theLaerdal Foundation to run a master trainingcourse on ‘Helping Mothers Survive BleedingAfter Birth’.

The course, conducted in collaboration withJhpiego and the Laerdal Foundation, was heldprior to the first FIGO Africa RegionalConference in Addis Ababa.

Representatives from seven African countrieswere trained by Jhpiego using the LaerdalFoundation’s MamaNatalie® Birthing Simulators.

Professor Hamid Rushwan, FIGO ChiefExecutive, said: ‘A pivotal aim of FIGO is toensure the availability of appropriately trained andequipped healthcare providers who are able toimplement life-saving techniques for the benefitof mothers and babies on the day of birth.

‘This excellent and highly practical workshop isa good example of an interactive learningmethodology which will no doubt contribute toimproving the quality of care in deliveryservices.

‘FIGO hopes to institutionalise similar trainingprogrammes at its national and regionalCongresses.’

September brought the new FIGO project for‘Improving the Quality of Maternal andNewborn Healthcare Services ThroughAccelerated Implementation of the EssentialInterventions by the Healthcare Professionals’Associations’ into sharp focus, as twoinception workshops were held in Jakarta,Indonesia, and Kampala, Uganda.

This project, involving FIGO, the InternationalConfederation of Midwives (ICM) and theInternational Pediatric Association (IPA) leading amulti-stakeholder plan of action in Uganda andIndonesia, focuses on implementing 17 EssentialInterventions relating to Childbirth and Postnatalcare. Support from the World Health Organization(WHO) has been central to its development.Activities are being undertaken within two referrallevel health facilities in each country with the aimof increasing the capacity of the participatingobstetricians, midwives and paediatricians tointegrate the selected Essential Interventions intoclinical practice.

The project’s ultimate aim is for a tested andreplicable package of tools for implementing theselected Essential Interventions in low- andmiddle-income countries to be made available.Monitoring and Evaluation (M&E), a keycomponent, has been provided by the Institutefor Clinical Effectiveness and Health Policy (IECS– Instituto de Efectividad Clinica y Sanitaria)through the development of an M&E Strategy.

A broad stakeholder baseBoth countries will seek support from theirMinistries of Health (MoH) and WHO countryoffices; will make best use of other activitiesimplemented by civil society organisations (CSO);and will collaborate with academia. The privatesector will also be involved eg the acquisition ofequipment such as the MamaNatalie® BirthingSimulator (courtesy of the Laerdal Foundation).

Uganda participants

International HCPAs attended the inceptionworkshops and conducted visits to the selectedhealth facilities and meetings with the relevantstakeholders. The main objectives were toexplore opportunities and share lessons learnedfrom related national initiatives – thesediscussions informed the planned actions forincreasing coverage of the MNH EssentialInterventions. Besides the international andnational HCPAs, presenters included the MoH,WHO Geneva and WHO country offices, as wellas World Vision in Indonesia and ACHEST inUganda, representing the CSO Coalition who areleading MNH-supportive projects. These keynational institutions will be part of the NationalSteering Committee.

Participating affiliates:

Strength in partnership: an effective route tosuccess

Professor Hamid Rushwan, FIGO ChiefExecutive, said: ‘These valuable workshops wereessential to set the scene of this importantproject, covering areas such as the initiative’svalue, purpose, vision and key strategies, Themain objectives were analysed in depth: to

accelerate dissemination mechanisms for theinterventions; to institutionalise qualityimplementation to ensure future sustainability;and to establish strong collaborative workbetween stakeholders.

Indonesia participants

‘Strategically focusing on the birth and postnatalperiod – covering a critical period for mothersand newborns – brings a valuable opportunity forobstetricians, midwives and paediatricians towork collaboratively, culminating in a change inpractice in relation to the selected EssentialInterventions. A complementary package ofactivities – including mentorship, commodityreviews, team building sessions and caseconferences – to promote joint learning, qualityimprovement and a motivated health workforce isat the very heart of the national plans of action.’

He added: ‘I consider this project to be animportant milestone in establishing collaborative

work betweenthe three keyprofessionalorganisations atthe health facilitylevel. FIGO, ICMand IPA considerit a professionalresponsibility towork with theirmemberassociations at

country level. This will contribute enormously tothe improvement of maternal and newbornhealth, especially in low- and middle-resourcecountries.’

FIGO will report on project progress in the nextissue.*This article was prepared with the assistance of Amata Kwizera,Project Manager

PEOPLEMr David Bloomer founded The Global Library of Women’sMedicine with his wife Paula.

After studying law at Oxford and qualifying as a barrister-at-law,David has spent nearly all his professional life in medical publishing,founding his first publishing company in 1969, and later TheParthenon Publishing Group which, from its offices in London andNew York, published peer review journals and medical textbooksranging across the whole field of medicine, with a special focus onwomen’s health.

Since retiring, David has made use of his vast experience to explorenew ways of sharing medical knowledge, particularly in parts of theworld where traditional methods of publishing are handicapped bydistribution challenges and cost considerations. Thanks to his long-standing association and friendship with Professor John J Sciarra, aformer FIGO President, the concept for The Global Library ofWomen’s Medicine was developed in 2006 and the programmelaunched in 2008.

David manages GLOWM from the UK, supported by a strong team.The project is being continuously expanded and increased emphasis

is currently being given to the needs of less-resourced countries, with a committee established toexplore new initiatives in this area. Since www.glowm.com is entirely free to all users, accepts noadvertising and has no commercial objectives, David and Paula are continuing to look for supporters toassist in financing the Foundation so that it can maintain the site and expand this unique initiative inglobal medical education.

Q and A with David Bloomer, founder ofThe Global Library of Women’s MedicineDavid, what is the ethos behind The Global Library of Women’s Medicine?The simple objective of The Global Library of Women’s Medicine is to make a contribution to theenhancement of women’s healthcare around the world. It tries to do this by making available expert,up-to-date and peer-reviewed clinical guidance formedical professionals that is entirely free and accessibleby anyone, anywhere.

Thanks to the generosity and support of over 900experts from many different countries The GlobalLibrary now features a truly vast, and constantlyexpanding, range of resources. These include 446specially commissioned chapters on most aspects ofwomen’s medicine; a growing range of new textbooks;masterclass lectures; educational and surgical filmsand diagnostic atlases – all of which are principally fordoctors – as well as skills videos; tutorials; wall charts;and other resources for nurses and midwives. There isalso an expanding range of resources for communityeducation, and a special section focused on women’shealth rights and empowerment.

What attracted you about collaboration with FIGO?FIGO is by far the most important globally unifying force in women’s medicine seeking, as it does, to sethigh standards of best practice for adoption around the world. I have personally worked closely withFIGO for more than 25 years on a number of important projects and I have seen its impact grow and itsoutreach develop in a most impressive way, so I am delighted that The Global Library is now able tocollaborate with it in such a close way.

Since within our own sphere of activity we share exactly the same objectives as FIGO, it is enormouslyhelpful to have FIGO’s support in developing the work that we do. It helps us to focus on the mostimportant current issues, to interact with more people in more countries around the world and toidentify and develop the most needed new resources. In return, I hope that our role as an officialeducation platform for FIGO will make at least some small contribution to FIGO’s own global mission.

How will this collaboration evolve?We are already working with FIGO in order to play a supporting role in some of its upcomingprogrammes, and we expect that this will develop further in the future. We are also actively looking atways in which we can make access to knowledge at all levels easier and more effective, so, in, additionto the internet, we are now using print, smartphone technologies and other options to enhance theavailability of our resources, and some of FIGO’s.

One example of our collaboration with FIGO arose at FIGO’s recent first Africa Regional Conference ofGynecology and Obstetrics, held in Addis Ababa in October. At that meeting we recruited over 80‘Ambassadors’ who have agreed to accept from us memory sticks featuring almost all the resources of

The Global Library, plus some selected resources from www.figo.org. TheAmbassadors will use these memory sticks to download this material directlyonto their local medical school and hospital library computers. Therefore,doctors and students at these medical schools and hospitals will beguaranteed instant access to all this valuable clinical guidance regardless ofinternet availability – in significant parts of Africa the internet is still either notavailable or very slow, so we hope this will be a genuinely worthwhile initiative.

Of course, this is only one example of the many ways in which I hope ourcollaboration will lead to useful developments in the future.A ‘highly commended’ citation from the British Medical Association has just been awarded toGLOWM’s new, specially commissioned Comprehensive Textbook of Postpartum Hemorrhage.It was edited by Professor Sir Sabaratnam Arulkumaran, FIGO President, and colleagues, andis available to download from www.glowm.com

New faces at FIGOFIGO is delighted to announce the recentappointment of two new key staffmembers, based at the London Secretariat.

Laura Banks: NewProject Manager forFIGO’s initiative onInstitutionalisingImmediate Post-Partum IUDServices.

Laura has ahumanitarian andresearchbackgroundencompassingprogrammemanagement

experience with the Feinstein InternationalCenter at Tufts University in Boston and withValid International in Oxford, and supportingprojects relating to nutrition, livelihoods andthe environment; she holds a BA inDevelopment Studies, with qualifications inepidemiology and nutrition in emergencies.

She said: ‘I am very excited to have joinedFIGO and to have the opportunity to beinvolved in such an exciting and interestingproject from the early stages, with suchpotential to impact as it grows! I very muchlook forward to the challenges and

achievements ahead’.

Amata Kwizera: New ProjectManager for the FIGO-ICM-IPAproject: ‘Improving the Quality ofMaternal and Newborn HealthcareServices Through AcceleratedImplementation of the EssentialInterventions by the HealthcareProfessionals’ Associations’. She isalso overseeing the FIGO Projectfor Promoting Advocacy for BetterPractices in Post-PartumHaemorrhage and Pre-eclampsiaand Eclampsia.

Amata holds a Masters in PublicHealth, having previously worked

for IPAS and on HIV activities in Mozambiquewith Johns Hopkins University.

She said: ‘When I collaborated for thecreation of the ob-gyn association inMozambique (AMOG), I saw the greatpotential of professional associations to drivechange in practice. This potential growsexponentially when different associationswork together as is the case in the JointInitiative by FIGO, ICM and IPA. I do hopethat by documenting and sharing thedifferent experiences around the world, wewill make the FIGO affiliates stronger!’

Professor Hamid Rushwan said: ‘We aredelighted to welcome these very capableProject Managers to FIGO House. We wishthem well in their respective endeavours, andlook forward to updates on their activities.’

Mr David Bloomer Laura Banks

Amata Kwizera

6 In ternat iona l Federat ion of Gynecology and Obstet r ics | December 2013

7In ternat iona l Federat ion of Gynecology and Obstet r ics | December 2013

FIGO EVENTSAddis Ababa welcomes first FIGO AfricaRegional Conference of Gynecology andObstetrics – October 2013

The FIGO leadership with conference officials

The first FIGO Africa Regional Conference ofGynecology and Obstetrics, held in AddisAbaba from 2–5 October 2013, was a ‘greatsuccess’, attracting over 800 attendees fromapproximately 70 countries.

Professor Hamid Rushwan, FIGO ChiefExecutive, said: ‘This long-awaited majorconference has enabled international participantsto meet with both local and world-renownedexperts in obstetrics and gynecology, and to beupdated on the most critical current issues.

‘In particular, the popular Pre-ConferenceWorkshops – with topics ranging from Non-Communicable Diseases, Infertility and AssistedReproduction in Developing Countries,Perspectives in Leadership and MinimallyInvasive Gynecologic Surgery – providedattendees, at all levels, with the very latest,cutting-edge knowledge and techniques.’

First General Assembly for AFOGProfessor Rushwan continued: ‘The Conferencewas also notable for holding the important firstGeneral Assembly of the African Federation ofObstetrics and Gynaecology (AFOG), which wasformally launched at last year’s FIGO WorldCongress in Rome.

‘We were extremely pleased to welcome AFOGmembers from Nigeria, Cameroon, Benin,Burkina Faso, Guinea, Sudan, Kenya, Uganda,

Ethiopia, Mozambique, Gabon, Senegal, Mali andZambia. It was agreed to hold the next AFOGmeeting in early 2014, in Sudan, to continuediscussion on matters such as the formation ofthe new Executive Board, and to finalise plans forthe Federation’s initial activities for the promotionof women’s health.

Professor Yirgu Gebrehiwot, Conference President andAFOG President

‘Sincere thanks are due to the sterling efforts ofthe Conference President, Professor YirguGebrehiwot; the Organising, Scientific and LocalCommittees, notably their ChairpersonsProfessor Luis Cabero-Roura, Dr Hani W Fawzi,and Professor Yirgu Gebrehiwot respectively; andall other staff who worked so tirelessly to makethe Conference such a rich experience.’

Countries with the most representatives:Ethiopia, Sudan, Nigeria

Dr Hani W Fawzi, Chair of the Scientific Committee

FOGSI and FIGOhighlight recentadvances inobstetrics andgynecologyThe FOGSI-FIGO International Conferenceon ‘Recent Advances in Obstetrics &Gynaecology’, held at HyderabadInternational Convention Centre in mid-September 2013, was organised by FIGO,FOGSI and OGSH. The conference was anenormous success, with many eminentinternational and national figureheads inattendance, and it attracted huge numbersof delegates from all over India.

According to organisers Dr NarendraMalhotra (FOGSI representative to FIGO) andDr Shantha Kumari (Organising Secretary):‘The Conference provided an excellentopportunity to forge new relationships and toexchange views and opinions withprofessionals from across the country andglobally on critical issues of women’s health.’

The FIGO leadership with conference officials

Diary Dates1–5 February 201457th All India Congress of Obstetrics andGynaecology 2014 (Patna, India)www.aicog2014patna.com/20–23 February 201419th World Congress on Controversies inObstetrics, Gynecology & Infertility (COGI)(Macau, China)www.congressmed.com/cogimacau20–23 February 20143rd International Congress on CardiacProblems in Pregnancy (Venice, Italy)www.cppcongress.com

4–6 April 20145th Congress of the Asia Pacific Initiative onReproduction (Brisbane, Australia)www.aspirecongress.org/24–26 April 2014XII Annual Meeting of the MediterraneanSociety for Reproductive Medicine (MSRM) &COGI-BCGIP (Barcelona, Spain)www.comtecmed.com/MSRM/2014/FIGO accepts no responsibility for the accuracyof the external event information. Inclusion ofany event does not necessarily mean that FIGOeither endorses or supports it.

5–8 March 201416th World Congress of GynecologicalEndocrinology (Florence, Italy)http://isge2014.isgesociety.com/28–30 March 2014RCOG World Congress 2014 (Hyderabad, India)www.rcog.org.uk/rcog2014

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30 October–2 November 2014FIGO-SAFOG-SLCOG Conference(Colombo, Sri Lanka)www.figo-safog2014colombo.org/index.html