InternationalFederationofGynecologyandObstetrics
FIGOMission
• The International Federation of Gynecology and Obstetrics (FIGO) is a unique organization, being the only international professional body that brings together 130 obstetrical and gynecological associations from all over the world.
• FIGO is dedicated to the improvement of women’s health and rights and to the reduction of disparities in health care available to women and newborns as well as to advancing the science and practice of obstetrics and gynecology. The organization pursues its mission through advocacy, programmatic activities, capacity strengthening of member associations and education and training.
INEQUITIES
10/100.000
1000/100.000
InternationalFederationofGynecologyandObstetricsWorkingGrouponGoodClinicalPracticeinMaternal-FetalMedicine
Chair: G C Di Renzo
Expert members:E Fonseca, BrasilE Gratacos, SpainS Hassan, USAM Kurtser, RussiaF Malone, IrelandS Nambiar, MalaysiaM Sierra, MexicoK Nicolaides, UKH Yang, China
Expert members ex officio:C Fuchtner, FIGOM Hod, EAPMGH Visser, SM CommitteeE Castelazo , CBET CommitteeL Cabero, WG GDMV Berghella, SMFMY Ville, ISUOGM Hanson, DOHaD, WG NutritionPP Mastroiacovo, ClearinghouseJL Simpson, March of DimesD Bloomer, GLOWM
InternationalFederationofGynecologyandObstetricsWorkingGroupontheChallengesofLabour andDelivery
Chair: R Romero
Expert members:D Farine, CanadaMT Gervasi, ItalyJ M. Robson, IrelandT Duan, ChinaS Rosales, MexicoT Kimura, JapanL Yeo, Korea-USA
Expert members ex officio:C N Purandare, FIGOG C Di Renzo, FIGOM Stark, NESAGH Visser, SM CommitteeE Castelazo , CBET CommitteeC Lees, RCOGA Conde’ Agudelo, NIH NICHDD Bloomer, GLOWM
International Federation of Gynecology and ObstetricsMarch of DimesWorking Group on Preterm Birth Prevention
Chairs: J L SimpsonG C Di Renzo
Expert members:Ernesto CastelazoMary D’AltonEduardo FonsecaChris HowsonBo JacobssonJames MartinJane NormanT Y Leung
Expert members ex officio:CN Purandare, FIGOJ Howse, March of DimesG Visser, SM CommitteeD Bloomer, GLOWMJim Larson BCGDavid Ferrero, BCG
International Federation of Gynecology and ObstetricsGDM initiative
Chair: M Hod
Expert members:Mukesh AgarwalBlami DaoGian Carlo Di RenzoHema DivakarEran HadarAnil Kapur
Expert members ex officio:CN Purandare, FIGOGH Visser, SM CommitteeD Ayres do Campo, SM CommL Cabero, CBET CommitteeD Bloomer, GLOWMR Fabienke, Novo Nordisk
Good practice advice
• Folicacidsupplementation•Predictionandpreventionofpretermbirth•Noninvasiveprenataldiagnosisandtesting
Good practice advice
• Thyroiddiseasesinpregnancy•MgSO4useinobstetrics•Appropriateuseofultrasoundinpregnancy•Hyperglycemiaandpregnancy
GoodpracticeadvicefinalisedinJune2016
•AspirinUseinPregnancy• Irondeficiencyanaemia•ManagementofTwinPregnancy•MicronutrientsinPregnancy
GoodpracticeadvicetobediscussedonDecember2016
• Intrauterinegrowthrestriction•RecurrentMiscarriage•Predictionofpreeclampsia
Preconceptional folic acid for the prevention of NTD
FIGO Recommendation StatementMethods: a systematic review of the evidence on folic acid supplementationin women of childbearing age published, including review and peer-reviewedpapers, government publications, and statements from others societies wasused to develop a new clinical practice guideline for the InternationalFederation of Gynecology and Obstetrics.
Objective: to provide information regarding the use of folic acid for the prevention of NTD, and also standardize strategies in the primary prevention of NTD providing an adequate orientation according to scientific bases for all childbearing women.
GOOD PRACTICE ADVICE
• Folic acid supplementation has been proven to be effective in the reduction of NTD.
• However, take into account that nearly 50% of pregnancies are unplanned, and about 5-20% of all pregnant women start folic acid before pregnancy.
• the recommendation for preconceptional folic acid supplementation has to achieve both health workers and childbearing women.
Results
GOOD PRACTICE ADVICE
ThisreviewoffiveRCT,involving6105women(1949withaHxofapregnancyaffectedbyaNTDand4156withnoHxofNTDs),confirmsthatfolicacidpreventsthefirstandsecondtimeoccurrenceofNTDs.
Reductionof72%
Supplementationwithfolicacidversusnotreatment/othermicronutrients/placeboforNTD
GOOD PRACTICE ADVICE
16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 462 4 6 8 10 12 14 48
Gestational age,weeks
Days
3° 4° 5° 6° 7°
16 18 20 22 24 26 28 30 32 342 4 6 8 10 12 14
Firstheartbeat 4-chamber
EmbryonalageDays
Neuraltubecloses
FirstdayofLMP
Conception(mean)
Pregnancymaybesuspected(mean)
Firstantenatalvisit
• Upto50%ofpregnanciesareunplanned,• About5-20%ofallpregnantwomen
startfolicacidbeforepregnancy.
Before conception,since a fertility control method is stoppedup to the end of the first trimester
When
GOOD PRACTICE ADVICE
§ Nutritional guidance and food fortification
§ Periconceptional supplementation
§ Folic acid in association with pills
Folic Acid in the strategy for NTD
GOOD PRACTICE ADVICE
All women who plans to become pregnant or all women atchildbearing age without contraceptive method and who doesnot present risk factors for NTD utilize 400 micrograms (0.4mg)of synthetic folic acid, beginning at least 30 days before theconception and to continue daily supplements throughout thefirst trimester of pregnancy.
RECOMMENDATIONFORLOWRISKPOPULATION
Expertpanelssuggestthatsupplementalintakeinthispopulationshouldrangefrom400µgto800µg,nomore.
First:
GOOD PRACTICE ADVICE
All women in the reproductive age group should be advised aboutthe benefits of folic acid supplementation during wellness visits(birth control renewal, Pap testing, yearly examination), especially ifpregnancy is contemplated.
RECOMMENDATIONFORINCREASINGTHEINTAKEOFFASecond:
GOOD PRACTICE ADVICE
WomenwhohaveNTD-affectedpreviouspregnancyshouldbeadvisedthatsyntheticfolicacidsupplementationatadoseof4,000mcgperday(4.0mg)isrecommended.Itshouldstartatleast30daysbeforetheconceptionandtocontinuedailysupplementsthroughoutthefirsttrimesterofpregnancy.
RECOMMENDATIONFORHIGHRISKPOPULATIONThird:
Inthisgroup,itwouldbeimportant;ifpossible,preconceptiongeneticcounselingwithaphysicianspecializedinmedicalgenetics.
GOOD PRACTICE ADVICE
Additionalguidance
Consideringthehighfrequencyofunplannedpregnanciesworldwide,theinternationalFederationofGynecologyandObstetricsencouragesalleffortsofpublicagenciesworldwidetowardsthedevelopmentofmorecomprehensiveprogramstofortifyfoodwithsyntheticfolicacidandmorevigilanceinmonitoringtheseprograms.
Pregnant women taking a multivitamin with folic acid supplementshould be advised not to take more than 1 daily dose of vitaminsupplement, as indicated on the product label.
GOOD PRACTICE ADVICE
CONCLUSIONS
FOCUSONGLOBALSTRATEGIES
AMELIORATEOURPROFESSIONOVERCOMINGTHELIMITSOFNATIONALSOCIETIESGUIDELINES:THEBESTPRACTICEADVICEGLOBALSTRATEGIESFOR:PRETERMBIRTHPREVENTIONNONCOMMUNICABLEDISEASESPREVENTINGEXPOSURETOTOXICCHEMICALS
FIGHTINGTHEINEQUITY
Gatheringdataonmaternalmortalityandmaternalhealthisnotoriouslydifficult.However,onethingisclearfromallthestatistics:althoughmaternalandperinatalmortalityandmorbidityisfallinggloballytheperspectivesforwomen-infantsinpoorresourcescountriesaremuchworstthanforthoseinindustrialisedcountries.
Accesstocare
HealthcareSystems/InsuranceCoverage
Education/Counseling
PreventivetoolsBest
Practice
Riskfactors/MarkersImplementation
Window of Opportunity
Pregnancyoffersawindowofopportunitytoprovidematernalcareservicestomotherandoffspring
Reducetraditionalmaternalandperinatalmorbidityandmortality
indicators
AddressintergenerationalpreventionofpretermbirthandNCDs,suchas
diabetes,hypertension,cardiovasculardisease,andstroke.
OnSept2015theUNGeneralAssemblyadoptedthe“Agenda2030:TransformingourWorld”,withaconsensusoftheWorldGovernmentCommunity- introduced17sustainabledevelopmentgoalsSDGs.ManyofthesuggestedSDG’shaveEnvironmentalandReproductivehealthembeddedintheirgoals
Itisasheerco-incidencethatSeptember2015witnessedthe20th anniversaryoftheBeijingWorldConferenceonWomenundertheslogan-“Planet50-50by2030:SetitupforGenderEquality”.
‘TheAgenda2030;Transformingourworld’ orPlanet50-50by2030’ i.e.SDGswillnotmaterialisewithoutthecontributionof50%ofitspopulationi.e.women- Thiscanbeachievedonlywithgenderequality,equaleducationandemploymentopportunities+providingsexualreproductivehealthandrights.
ReproductiveHealthandRightswillnotbecompleteunlessweimproveenvironmentalHealth
FIGOwasnotandwillnotbeapassiveobservertobringaboutthisrequiredchangeandwillacttomakethesedreamsrealforwomen.