Figo newsletter august 2012


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Figo newsletter august 2012

  1. 1. 10660:Layout 1 10/8/12 12:43 Page 1 International Federation of FIGO FIGO Gynecology and Obstetrics August 2012 FIGO prepares for global gathering@Rome 2012 The FIGO President delivering his address at the Executive Board dinner with Chinese officials Centres of Excellence in Italy, and it is also hosting seven Pre-Congress educational and training courses in Italian hospitals. I am highly encouraged by the enthusiasm of thousands of my colleagues from all over the world who have already registered for this Congress. Please do join us for what promises to be one of the most memorable ever, and during which we shall celebrate launching the new The FIGO President, with other participants, at a private Papal audience, on the occasion of the ‘Management of Infertility African Federation of Obstetrics and Gynecology Today’ Workshop, Vatican City (February 2012) (AFOG). I would like to thank the World Health Organization’s (WHO) Regional Office for Africa Dear Colleagues Congress venue (on registration, participants will for its staunch support of this forthcoming receive a free travel card for use on public Since our last communication in March, it has transport to be utilised throughout the Congress). enterprise. been an extremely busy time for FIGO! The social and cultural programmes are FIGO leading the way in global We have been accelerating our efforts to finalise outstanding and include a Papal Audience on arrangements for the FIGO XX World Congress in Wednesday 10 October. The Local Organising education and training Rome, from 7 to 12 October 2012. Committee is sponsoring 30 Fellowships for With rapid developments in science and young colleagues from developing countries in technology, and the evolution of evidence-based The Scientific Programme Committee has and person-centered management of various performed a wonderful job in compiling an women’s health conditions, it is essential to exceptionally strong programme incorporating strengthen our education and training basic- to cutting-edge knowledge in women’s programmes to enable the passing on of health. The agenda also involves top knowledge and skills to ‘grassroots’ obstetricians representatives of UN organisations, NGOs, and gynecologists in remote rural areas. Since sister professional organisations and October 2009, our Committee for Capacity policymakers as our collaborative efforts are Building in Education and Training has conducted essential to achieving the health-related more than 54 sessions and workshops around Millennium Development Goals (MDGs). The the globe, particularly in developing countries. Congress Organising Committee has been For example, an outstanding hands-on workshop working hard to ensure the comfort of all Members of the Executive Board participating in an attendees, and easy transportation to the educational seminar, Beijing (May 2012) continued on page 2 World Congress countdown | Executive Board meets in Beijing | Gynuity’s INSIDE: Beverly Winikoff | Dr André Lalonde reviews SMN Initiative | Latest from LOGIC International Federation of Gynecology and Obstetrics | August 2012 1
  2. 2. 10660:Layout 1 10/8/12 12:43 Page 2 FIGO prepares for global gathering@Rome 2012 Japan (April 2012): I met with the JSOG Continued from page 1 leadership and the Japanese International Cooperation Agency (JICA) to discuss the involvement of Japan in FIGO’s global women’s health activities. FIGO will develop a concept proposal to take this initiative forward. • 60th ACOG Annual Clinical Meeting (American College of Obstetricians and Gynecologists), San Diego, USA (May 2012): I discussed with ACOG’s leadership its support of FIGO’s Congress, and the progress of its initiative on global maternal health with FIGO, the Royal College of Obstetricians and Gynaecologists (RCOG) and the Society of Obstetricians and Gynaecologists of Canada (SOGC). • 38th NFOG Congress (Nordic Federation of Burkina Faso Workshop Societies of Obstetrics and Gynecology), Bergen, Norway (June 2012): I delivered a (one of a series) on ‘Ultrasound and Basic In May I participated in the 5th International lecture on ‘Ethics in Human Reproduction and Surgical Skills’ for 40 obstetricians and 30 Parliamentarians’ Conference on the Women’s Health’. I discussed with Professor midwives was organised in Burkina Faso by Implementation of the International Conference Knut Hordnes, Congress President, and Dr Professor Eric Jauniaux, in collaboration with the on Population and Development (ICPD) Goran Berg, NFOG President, strengthening Societé de Gynécologues et Obstétriciens du Programme of Action, in Istanbul, organised by collaboration and coordination between FIGO Burkina (SOGOB). UNFPA and the European Parliamentary Forum and NFOG in developing countries where FIGO Following on from the success of the hands-on on Population and Development (EPF). I and NFOG both have ongoing progress. workshop on Minimally Invasive Surgery (MIS), presented in the first plenary session of the • 68th SOGC Annual Clinical Meeting, Ottawa, held in Khartoum last February, a further course conference a lecture on ‘Scaling up Strategies to Canada (June 2012): This presented a special is scheduled there from 17–20 September 2012, Reduce Maternal Deaths: Achievements and opportunity to discuss strengthening while another is planned for the Ukraine. Thanks Persistent Challenges’. collaboration between FIGO and the SOGC in are due to Olympus Surgical Technologies In June, I held a meeting with UNFPA’s Deputy the light of the new SOGC leadership, and also Europe for its robust support of this programme. Executive Director (Programme) and the the selection of Vancouver as the site of the As Dr David Adamson (Chair of the FIGO Assistant UN Secretary-General Dr Kate Gilmore 2015 Congress. The highlight of this meeting Committee for Reproductive Medicine) and during her exploratory visit to Africa. I discussed was attending the Council and the Past myself were very encouraged with the great with her how best we can utilise Faith-Based Presidents’ dinner where I was awarded the success of three workshops on ‘A Basic and Organisations for the implementation of ICPD’s Honorary SOGC Fellowship. I am immensely Advanced Clinical and Laboratory Training PoA, and achieving the health-related MDGs, and proud to be recognised in this way, and am Course in Infertility, including ART for Developing shared IICPSR’s experience at national, regional grateful to the SOGC Council for bestowing Countries’, a fourth workshop is planned in and international levels. this great honour. collaboration with the International Islamic Center Also that month, FIGO joined the Population Our thanks to China: for Population Studies and Research (IICPSR), Al Council and Reproductive Health Supplies Azhar University, from 8–12 December 2012. Coalition (RHSC) and held a meeting on Long- Executive Board 2012 Many thanks to IBSA International for its support Acting, Reversible Contraception (LARC) in Our 72nd Executive Board meeting was held in of these Committee activities. Bellagio. The group produced a statement which Beijing, China, in May 2012. It was a superbly The Executive Board endorsed the Training was submitted to a special London Summit organised event, and it well reflected that FIGO’s Curriculum on Bioethics in Human Reproduction meeting – which I attended – organised in July by relationship with its member societies is getting and Women’s Health for Developing Countries, the UK Government, the Bill & Melinda Gates stronger and stronger. In fact, we have already developed by the FIGO Committee for Ethical Foundation and UNFPA. Many Presidents, First received requests to host the 2013 meeting from Aspects of Human Reproduction and Womens Ladies, Ministers and leaders from UN several member societies. I know that both FIGO Health. This Curriculum will be a tremendous help organisations and NGOs attended. A video staff and Board members were overwhelmed by for developing countries both in pre-service and message was sent from Hillary Clinton, and an the great hospitality and warmth of our Chinese in in-service training of healthcare professionals. I address given by UK Prime Minister David colleagues, and their excellent organisation. I am sincerely thank Ford Foundation for its support of Cameron. The meeting was extremely extremely grateful to the Chinese Government this project. successful, with pledged commitments of 2.6 and the Chinese Society of Obstetrics and billion US dollars from donor governments and Gynecology (CSOG) for their kindness and their The FIGO Fistula Initiative – ensuring high quality other partners, and 2 billion US dollars from commitment to the overall success of this clinical training for the care of women with developing countries, to provide for the unmet important annual event. obstetric fistula – is progressing well. need for contraception for 120 million women Accreditation for training centres has taken place and girls in developing countries by 2020. Shortly and training centres are now identified (see after this Summit, FIGO met with the Population Professor Rushwan’s report on page three). Council and the RHSC to discuss how best to Thanks are due to the United Nations Population utilise the statement to improve access to LARC. Fund (UNFPA), and a host of other high profile partners. Strengthening collaboration with MDG 2015 Countdown and member and regional societies FIGO global partnerships Over the past few months I have participated in a large number of regional and national society The FIGO Executive Board visiting the Beijing Obstetrics FIGO has joined forces in global efforts to meetings, delivering presentations, chairing and Gynecology Hospital accelerate progress to achieve the health-related sessions and workshops and holding meetings Millennium Development Goals. On invitation and discussions with key society representatives. Colleagues and friends: as I end this message, from the Director of WHO’s RHR/HRP, I there is still a great deal for FIGO to accomplish participated in the 29th Scientific and Technical These included: before the start of the Congress. I am very much Advisory Group (STAG) meeting held in Geneva • 64th JSOG Annual Congress (Japanese looking forward to welcoming you all to what I in February. Discussions mainly centred on the Society of Obstetrics and Gynecology), Kobe, know will be one of the most memorable FIGO strategic direction of the department and the Congresses since the start of its history. HRP research breakthroughs contributing to I wish you a productive summer and safe travels saving women’s and children lives. to Rome. In February, I participated in a special workshop, Best wishes ‘The Management of Infertility Today’, organised by the Pontifical Academy for Life, the Vatican, Italy, delivering a lecture on ‘The Global Changing Prevalence of Infertility’, and its impact on population policy and family planning. The highlight of the visit was a private Papal 64th JSOG Annual Congress (Japanese Society of Audience. Obstetrics and Gynecology), Kobe, Japan (April 2012) FIGO President Gamal Serour 2 International Federation of Gynecology and Obstetrics | August 2012
  3. 3. 10660:Layout 1 10/8/12 12:43 Page 3 CHIEF EXECUTIVE’S OVERVIEW FIGO@Rome 2012: The place to be Dear Colleagues Training Initiative using FIGO’s Training Manual, and a course for the Training of Trainers will be By the time you receive conducted in Addis in the very near future. The this summer edition of Hamlin Fistula Hospital will provide an excellent the Newsletter, the XX training facility for the FIGO Initiative. FIGO World Congress will be just a few short In Tanzania, we visited the Comprehensive weeks away. The Community Based Rehabilitation Tanzania various organising (CCBRT), a well recognised hospital with an Committees are putting impressive track record of fistula activity. Two the finishing touches to experienced surgeons are ready to participate in what will be a most the Training Initiative, utilising the manual, and tremendous event. If Fellowships are being finalised for training eight FIGO Chief Executive, Hamid Rushwan you have not already trainers and a selection of trainees. done so, please secure your registration at The last site we visited was in Arusha, where Dr Beijing press conference to avoid Andrew Browning provides general obstetrical disappointment. This triennial FIGO event is the and gynecological services in a new hospital. Conference – held in partnership with the culmination of three years’ exceptional hard work There are only a few fistula cases being treated Obstetrical and Gynaecological Society of and planning, and we are thrilled that so many of here, and therefore the centre is not able to Malaysia (OGSM) – where I chaired a FIGO- our global colleagues are set to join us. More accommodate or provide training. However it is sponsored session: Misoprostol for the news about the Congress can be found on page anticipated that training will be conducted in prevention and treatment of post-partum 10. Arusha on an ad-hoc basis, depending on the haemorrhage: From clinical evidence to Meetings and travels have been extremely brisk caseload for trainees. operational realities (see our update on FIGO’s since my last reporting. In early March, I attended misoprostol initiative on page nine). a Technical Consultation on the World Health Shortly afterwards, I flew to Washington to Organization (WHO) Recommendations on Post- participate in two important meetings: the ‘Child Partum Haemorrhage, in Montreux. The meeting Survival Call to Action’ organised by the United was held to review available evidence and update Nations Children’s Fund (UNICEF) and the United the global recommendations on prevention and States Agency for International Development management of post-partum haemorrhage (PPH) (USAID), and a preceding briefing/consultation – the leading cause of maternal mortality – and it meeting on Countdown to 2015 combined with a addressed major issues both for women who civil society forum about the ‘Call to Action’, give birth in a medical setting and for those who organised by Save the Children. deliver at home. The WHO and stakeholders are At June-end, I travelled to the WHO in Geneva to developing a new set of guidelines on the represent FIGO at the 25th Meeting of the Policy prevention and treatment of PPH, based on new and Coordination Committee (PCC), scientific evidence, and this will be circulated to Dr Catherine Hamlin with Chief Executive Hamid Rushwan and Lord Naren Patel Development and Research Training in Human stakeholders for endorsement. Reproduction (HRP) – the UNDP/UNFPA/WHO/World Bank Special Programme of Research. This meeting coincided with the 40th Anniversary Celebration of the HRP. Photo courtesy of the MCHIP Program Olympus and FIGO join forces on MIS I am extremely pleased to report that the first FIGO-Olympus Workshop on Minimally Invasive Surgery (MIS) – organised in conjunction with the Obstetrical and Gynaecological Society of the Sudan – was successfully conducted at Soba University Hospital, Khartoum, Sudan, at the end of February. This is as a result of a new WHO PPH meeting (Montreux) collaboration recently agreed with Olympus L–R (Gondar Fistula Centre): Fistula surgery trainee (from Bangladesh); nurse; Dr Ambaye Wolde Michael; Professor Surgical Technologies Europe, which is Fistula site visits set the scene for Hamid Rushwan; Dr Mulu Muleta; nurse; Lord Naren Patel sponsoring the establishment of three FIGO training centres in Africa, East Europe and accreditation FIGO held its annual Executive Board meeting in possibly Latin America, as well as the trainees At April-end, I travelled to Ethiopia and Tanzania Beijing, in May, and I would like to take this and trainers. with Lord Patel, Chair of the FIGO Committee for opportunity to thank once again the Chinese Society of Obstetrics and Gynecology (CSOG) for This highly successful Workshop set the optimum Fistula, to carry out site accreditation visits as its superb organisation of this important event (a standards for future events, and the second part of the planned implementation of the full report is on page five). We received great course will run from 17–20 September 2012. structured fistula surgery training programme hospitality from our Chinese hosts, and special FIGO would like to extend its gratitude to the using the Global Competency-Based Fistula mention must go to President Dr Jinghe Lang, Obstetrical and Gynaecological Society of the Surgery Training Manual, developed by FIGO and and Former President Dr Zeyi Cao. Sudan for its robust efforts in helping the partners. collaboration to achieve its goals. Four centres were visited. In Ethiopia, the Gondar The first course for MIS in Kiev, the Ukraine, is Fistula Centre (65-bedded), directed by Dr Mulu planned for September 2012. Details will be Muleta and Dr Ambaye Wolde Michael, was well available soon on equipped, but needs transportation to bring more patients from the surrounding rural areas, as well I wish you all safe travels to Rome, and a highly as additional equipment. In Gondar we met with enjoyable and successful few days at the a physician who had travelled from Bangladesh Congress. Thank you for supporting FIGO’s good to begin six weeks’ training in fistula surgery. He work. is part of a FIGO-organised training programme Best wishes that aims to increase the global number of physicians trained to provide treatment for women living with fistula. Executive Board in session We also visited the Addis Ababa Fistula Hospital, run under the guidance of Dr Catherine Hamlin. Keeping our global momentum This hospital is very well established, with six In June – a hectic month – I travelled to Kuching, satellite centres, and it has a large caseload. The Malaysia, for the Royal College of Obstetricians FIGO Chief Executive doctors are extremely committed to the FIGO and Gynaecologists’ (RCOG) 10th Annual Hamid Rushwan International Federation of Gynecology and Obstetrics | August 2012 3
  4. 4. 10660:Layout 1 10/8/12 12:43 Page 4 PEOPLE Q and A with Beverly Winikoff, MD, MPH (President of Gynuity Health Projects) After almost 30 models of research and implementation, How do you see Gynuity’s work with years of work on emphasising ways in which existing medicines Reproductive Health and health technologies could be provided in a FIGO progressing in the future? based in large more woman-centred fashion and made more As part of the ongoing collaboration, the organisations, available and acceptable. dissemination of new evidence on misoprostol in Dr Beverly Winikoff PPH management to providers is being facilitated opened the doors Dr Winikoff, how did Gynuity’s by FIGO via a number of expert panels planned of Gynuity Health relationship with FIGO evolve? and implemented at national, regional and Projects in international meetings, including the 2012 FIGO Gynuity and FIGO have an extensive history of 2003. Gynuity World Congress in Rome where a half-day collaboration on several special initiatives aimed (, as session is planned. New materials, including at addressing principal causes of maternal it is more commonly training tools, protocols and guidelines on the Beverly Winikoff, MD, MPH, mortality, including post-partum haemorrhage known, is a small use of misoprostol in PPH management, are also President of Gynuity Health (PPH). Over the years, we have joined forces to Projects research and technical forthcoming in several languages. To highlight help translate key findings of clinical research assistance organisation with an energetic 30- new research and its implications as findings (implemented by Gynuity and other international become available, a number of peer-reviewed strong staff base, most of whom are public agencies) into policy guidance and clinical health professionals. scientific articles and special publications will also protocols. FIGO, along with other international appear in FIGO’s specialist global publication, the agencies, has joined a five-year initiative led by International Journal of Gynecology & Obstetrics Gynuity [see page nine] with the aim of translating (IJGO). a large and growing body of scientific evidence on misoprostol for PPH into operational reality, so Our project on misoprostol has allowed us to that all women will have access to a uterotonic ask, and try to answer, such provocative for the prevention and/or treatment of PPH. questions as: • How can we use the potential of misoprostol Gynuity is dedicated to the idea that all people The initiative, funded by the Bill & Melinda Gates for treatment as well as for prevention of PPH? should have access to the fruits of medical Foundation, encompasses a range of scientific, • Since some women will develop excessive science and technology, and it works globally to operational and policy issues related to the use of post-partum bleeding no matter what ensure that reproductive health technologies are misoprostol for PPH care. As a part of this prophylactic they are given, how can we widely available at reasonable cost, provided in collaborative effort, FIGO plays a critical role in encourage health systems to plan treatment the context of high-quality services, and offered advocacy for and dissemination of evidence- strategies at the same time as they are being in a way that recognises the dignity and based information for providers and clinical urged to develop prevention programmes? autonomy of each individual. Efforts are focused policymakers. Its member societies continue to • Can misoprostol be used for both prevention particularly on resource-poor environments, be instrumental in setting and advancing the and treatment in the same woman? underserved populations, and challenging standards of PPH care locally, including the • Is it easier and more cost-effective to use subject matter. Dr Winikoff saw in a small integration of evidence- based norms on the use oxytocin in Uniject or misoprostol for prevention organisation the opportunity to create flexible of misoprostol. in community-based programmes? • Can women be given misoprostol to self-administer for prevention of PPH in home IJGO: from strength to strength in 2012 births? FIGO’s official publication, the International Journal of Gynecology What do you find most satisfying & Obstetrics (IJGO), has continued and challenging about your work? its success over the past 12 It is extremely gratifying to see the blossoming of months and is experiencing a collaborations and to be able to join with like- particularly busy year in 2012. minded colleagues in projects that create Clare Addington, IJGO Managing change. An exhilarating part of Gynuity’s work is Editor, said: ‘The most recent Impact the opportunity to follow creative leads in Factor, for 2011, 2.045, is its highest research on women’s health. We push ourselves to date, and in 2011 the journal to look for new ways to provide services and new received 1323 submissions. The technologies to incorporate in them. We aim to 2011 acceptance rate is predicted to develop safe and effective, affordable, acceptable be 22 per cent and the Journal technologies that are delivered in a woman- continues to increase the annual friendly way, and enhance the autonomy and number of reviewers (702 in 2011) well-being of each person. and the geographic representation of Our collaboration with FIGO is particularly IJGO Editorial Board Meeting in progress (London, February 2012) those contributing reviews.’ precious to us for its potential to have real impact The annual meeting of the IJGO Editorial Board was convened in London in February 2012 and on women’s lives. By mustering the power of the was attended by its Editor – Dr Timothy Johnson – Associate Editors, and members of the Editorial ob/gyn community in support of new ways to Office. The meeting reviewed the content of the FIGO 2012 World Report attend to women having babies, especially in the on Women’s Health, which will be guest edited by FIGO’s President- poorest and most underserved areas of the Elect, Professor Sir Sabaratnam Arulkumaran, and will be published in world, our research becomes meaningful. We are time for the FIGO 2012 Congress in Rome. The Report comprises 20 very grateful for the opportunity. articles under the challenging topic of ‘Improving Women’s Health’, and For more information on Gynuity’s activities, visit contains contributions from, among others, authors from FIGO’s Committees, project teams, and collaborating organisations. Clare added: ‘A particular focus of the Editorial Board Meeting was the development of the IJGO website – – and opportunities for implementation of new technologies for reader interaction, such as video hosting.’ Dr Timothy R B Johnson, At the FIGO Congress in Rome, IJGO will host an author workshop IJGO Editor entitled ‘An Insiders Guide to Getting Published’, to be held on Thursday 11 October. The session is an opportunity for authors to hear from IJGO’s editorial team about how to maximize their chances of getting their research published – from understanding the submission process and article requirements, to tips from the Editor about what the Journal is looking for and from Associate Editors giving insights into how to develop and write a paper. This year will also see the publication of two IJGO Supplements, the FIGO Cancer Report, and an online book of the abstracts presented at the FIGO Congress. Clare ended: ‘In April, we welcomed Helen Metherell as a new Editorial Assistant. We are delighted to have her on board and look forward to a productive second half of 2012.’ 4 International Federation of Gynecology and Obstetrics | August 2012
  5. 5. 10660:Layout 1 10/8/12 12:43 Page 5 Beijing welcomes FIGO for 2012 Executive Board Meeting The 2012 FIGO Executive Board Meeting was seminars, and to CSOG for its tremendous held at the Crowne Plaza Park View Wuzhou contribution in helping us to run the events so Beijing Hotel, Beijing, China in May 2012, in smoothly and successfully.’ conjunction with the Chinese Society of Obstetrics and Gynecology (CSOG) and Seeing the Chinese picture supported by the Beijing Royal Integrative A briefing session on the state of women’s health Medicine Hospital. in China and, in particular, maternal and newborn Chief Executive Hamid Rushwan said: ‘FIGO health, was held during the trip. Representatives would like to thank its Chinese hosts – most of CSOG, the Ministry of Health and a number of especially CSOG’s President Dr Jinghe Lang, and international organisations were invited to present Former President Dr Zeyi Cao – for a superbly an overview of women’s health to the Executive organised meeting and the accompanying Board meeting participants. FIGO seminar speakers in Chengdu excellent hospitality which was greatly appreciated. The event was a valuable encompassed the broad spectrum of global opportunity for FIGO officials to “touch base” with women’s health issues, outlining FIGO’s activities our esteemed Chinese colleagues, and to in various countries. These activities formed the familiarise ourselves with current obstetrical and basis of the seminars’ educational topics, gynecological issues in this fascinating part of the drawing on the rich experience of our world. Committees and Working Groups. ‘Thanks are also due to the FIGO Secretariat staff ‘Lecture topics included maternal mortality, post- – Bryan Thomas and Marie-Christine Szatybelko partum haemorrhage, unsafe abortion, obstetric – for their usual excellent handling of all Board fistula, cancer prevention, ethics problems and Meeting arrangements.’ women’s sexual rights, and speakers comprised the Chairs of FIGO’s Committees and Working Groups, as well as Board Members. FIGO President Gamal Serour with the Minister of Health ‘It is always important that the host country plays a vibrant and significant role in the development FIGO field visit: focus on Beijing of these popular seminars, so the programme is Obstetrics and Gynecology Hospital traditionally completed with the contribution of its speakers and topics. China focused on its issues A visit to the well-regarded Beijing Obstetrics and of maternal mortality, early diagnosis of cancer, Gynecology Hospital took place during the trip: and preservation of fertility.’ founded in 1959, it is the largest obstetrics and gynecology hospital in Beijing, and highly Executive Board 2012 advanced in perinatology and women’s reproductive health. It is also notable for serving as a World Health Organization (WHO) research and training centre for women’s health in China. Executive Board in session Seminar participants He added: ‘We are pleased to report that attendance was superb – more than 700 students in Beijing and 300 in Chengdu – with plenty of discussion and participation among Chief Executive Professor Hamid Rushwan (right) with both students and speakers. We performed the hospital staff same anonymous multiple choice test questions before and after the seminar, and the results were similar in both: a 40 per cent increase in correct answers, which truly reflected the positive impact of these events.’ FIGO Administrative Director Bryan Thomas (left) and FIGO Senior Administrator and Committee Manager Marie-Christine Szatybelko with colleague Yonggang Shang A number of valuable related activities took place alongside the main Executive Board business: Women’s Health: FIGO President-Elect Professor Sir Sabaratnam Contemporary Challenges Arulkumaran (centre) views facilities The FIGO Committee for Capacity Building in Chief Executive Hamid Rushwan commented: Education and Training organises the now ‘This valuable visit provided FIGO with an traditional educational seminar during the period excellent overview of the state of current of the Executive Board Meeting. In China, two maternal and newborn healthcare in China. events were held, one in Beijing and one in President Gamal Serour (right) with CSOG’s Former ‘It was clear from our tour of the hospital that Chengdu, under a common theme: Women’s President Dr Zeyi Cao medical professionals have been trained to Health: Contemporary Challenges. He ended: ‘FIGO – in particular, the Committee rigorous standards: we were greatly impressed Professor Luis Cabero-Roura, Committee Chair, for Capacity Building in Education and Training – with their calibre and dedication, and the explained: ‘The seminar programme – starting wishes to express its sincere gratitude to the subsequent high quality robust care provided to with a lecture from the FIGO President – speakers who generously participated in the mothers and babies.’ International Federation of Gynecology and Obstetrics | August 2012 5
  6. 6. 10660:Layout 1 10/8/12 12:43 Page 6 SAVING MOTHERS AND NEWBORNS INITIATIVE Looking back; moving forward (2006–2011, funded by the Swedish International Development Cooperation Agency – – and FIGO) FIGO’s recently concluded Saving Mothers and care, thus preventing hundreds of maternal Newborns Initiative resulted in great challenges deaths. The Kenya project instituted clinical and opportunities for low- and middle-resource audits and mobilised the healthcare professionals countries in their quest to make a tangible (HCPs) to provide better care. The Pakistan difference in the reduction of maternal and project recruited and trained local women to newborn morbidity and mortality, and to the provide essential obstetrical care. achievement of MDG goals 4 and 5,’ said Dr ‘Each project was indeed unique and, despite André Lalonde, Project Director, and Chair of presenting huge administrative challenges, the FIGO Committee for Safe Motherhood and succeeded in mobilising HCPs – for many, this Newborn Health. Peru training was the first time that there had been a direct response to the needs of safe motherhood and objectives: to strengthen the capacity of national newborn care in their countries outside of their professional associations to engage in maternal clinical practices. and newborn health through the design and implementation of projects, and to strengthen co- A significant outcome operation between FIGO and national societies, ‘We are delighted to report that significant and and between societies in regions of differing largely sustainable results were achieved, economic levels. particularly in relation to the relatively small-scale ‘Further secondary aims were to strengthen the funding available, and this resulted in direct co-operation between national societies and the improvements to maternal and newborn health national stakeholders involved in safe outcomes. The capacity of both FIGO and motherhood and newborn health, and to national professional associations was also L–R: Dr André Lalonde, Chair FIGO SMNH Committee; Mr José Mujica, President Of Uruguay; Economist Daniel increase the credibility of national societies locally substantially strengthened in project design, Olesker, Minister of Health; Leonel Briozzo, director of to provide technical support to Ministries of management, and implementation, leading to project, Sub Secretario de Salud Pública Health (MoH) and national professional councils. opportunities to support international ‘Each project focused on identified needs within development efforts in the future. each country and resulted in varied approaches ‘One of the most notable achievements was the and targets, ranging from clinical training, provision of clinical training to more than 2,000 protocol development, and implementation of health professionals, including traditional birth clinical audit through to legislative and policy attendants, midwives, doctors, and obstetricians. change.’ ‘The SMNH Committee played no small part in Rising to the challenge the success of this enterprise – Committee Dr Lalonde explained: ‘From the very start, the members in different regions were tasked with challenges were immense, but the project elicited troubleshooting difficulties, therefore providing a tremendous enthusiasm in reacting to the needs cost-effective solution to problem-solving.’ Women and children, Uganda of pregnant women in the countries involved. Dr Lalonde concluded: ‘All programme directors ‘Some concrete examples of success: the are scheduled to present their results at a half- Uruguay project – how to manage unsafe day seminar at the FIGO World Congress, and a abortion in a country with very restrictive laws – is booklet will also be produced and made available a model for many countries. The Haiti project on’ responded to an enormous humanitarian disaster Full reports on the project’s activities (including [a severe earthquake] through making the project the individual country reports) are available on maternity centre one of the few maternities in this section of the FIGO website: Port au Prince able to offer essential obstetrical Explaining the challenges (Kenya project) The project in focus Laying the groundwork Selected achievements Haiti ‘Strengthening the health center of Croix des Bouquets’ Primary health clinic transformed into He continued: ‘The Committee worked with functioning hospital; ambulance purchased and on-call driver contracted associations of obstetricians, gynecologists and midwives in 10 low- and middle-resource Kenya ‘Improving quality of prenatal, delivery, and postnatal care through clinical audit’ Update of countries between 2006 and 2011, with clinical audit extended beyond maternity into general surgery contributions from professional associations in Kosovo ‘Reduction of maternal and newborn mortality’ First set of national standards developed high-resource countries through a structured by a clinical body produced by national association and approved by the MoH north-south mentoring programme. Moldova ‘Beyond the numbers - implementation of new approaches in reviewing perinatal deaths’ National registration of all perinatal deaths Nigeria ‘Saving mothers and newborns in Edo, Amambra, and Kaduna States’ Magnesium sulphate supplied to all state hospitals by Kaduna State Government; its cost reduced by manufacturers Pakistan ‘Community-based interventions to reduce maternal and perinatal mortality and morbidity in rural Sindh’ Training local women as midwives; renovations led to functioning operating theatre Peru ‘Improving obstetric and neonatal emergency care in Morropón Chulucanas Health Network, Piura’ Emergency Obstetric Care (EOC) and Comprehensive Essential Obstetric Care (CEOC) in rural mountain area audits Uganda ‘Reduction of maternal and newborn mortality’ Paradigm shift in professional Pakistan medical camp organisational thinking led to collaborative working with non-health community staff to achieve ‘The countries involved were: Haiti, Kenya, improved health outcomes for rural women Kosovo, Moldova, Nigeria, Pakistan, Peru, Ukraine ‘EmOC improvement by advances in labor and risk management (ALARM) international Uganda, Ukraine and Uruguay. program (AIP)’ Reduction in inappropriate clinical interventions during delivery ‘The main goal - that of contributing to the Uruguay ‘To protect the life and health of Uruguayan women by reducing unsafe abortions’ Policy reduction of maternal and newborn morbidity and and legislative change; Presidential support for the project; creation of a sexual and reproductive mortality to help achieve MDGs 4 and 5 – was health department within the MoH (headed by project director) complemented by critically important secondary 6 International Federation of Gynecology and Obstetrics | August 2012
  7. 7. 10660:Layout 1 10/8/12 12:44 Page 7 Dr André Lalonde FIGO Chair highlights importance of new PPH receives Queen Guidelines For many years, Dr Lalonde has been active in FIGO’s worldwide campaign to Elizabeth II Jubilee prevent PPH, promoting non-invasive treatments to prevent this devastating condition. medal He commented: ‘The FIGO Committee for Safe Motherhood and Newborn Health has completed a full review of the physiology of the Third Stage of Labour, and prevention Dr Lalonde continues his commitment to and management of PPH in low-resource reducing maternal mortality in low-resource countries. FIGO’s recently published countries and especially the prevention and Guidelines [available at treatment of post-partum haemorrhage (PPH). More recently, he led the Committee in uidelines], in the International Journal of developing FIGO PPH Guidelines. Gynecology & Obstetrics, are not only He is seen below with the Minister of International evidence-based, but include important Cooperation, Ms Beverley J Oda, at a ceremony clinical information to help all healthcare in Ottawa. She complimented Dr Lalonde on his professionals to tackle this huge problem.’ illustrious career and on how he ‘makes Canada He added: ‘The central recommendation is proud’. that all women should be offered an oxytocic A selection of Dr Lalonde’s drug at delivery. It also calls for community achievements: availability of trained personnel in midwifery • Leading the ground-breaking multi-disciplinary care, as well as supply of misoprostol [see Collaborative Primary Maternity Care Project. page 9] where oxytocin is not available. This enabled nurses, midwives, family ‘In particular, there are discussions on the physicians and obstetricians to work together cascade of medical and surgical treatment of effectively to ensure appropriate care. PPH, and recommendations on the use of • Pioneering a worldwide Maternal Risk uterine tamponade and the anti-shock Management programme to address maternal garment [NSAG]. and newborn mortality and morbidity. The ‘The Guidelines offer a logical approach, and ALARM International programme has been downloadable schemas that can be piloted and used in over 20 low-resource reproduced and used as posters in delivery Dr Lalonde receiving his medal from the Minister countries with great success. rooms.’ • Co-authoring Postpartum Hemorrhage On 21 June 2012 Dr André Lalonde, Chair of He ended: ‘Medical societies should Today, the definitive textbook on the subject. pressure all governments to supply the FIGO Committee for Safe Motherhood and • The LaSalle General Hospital in Montreal, necessary drugs and equipment to prevent Newborn Health, received the Queen Elizabeth where Dr Lalonde was Head of Obstetrics, and treat PPH, and therefore help to reduce II Jubilee Medal for his contribution to women’s recognised his dedication and named the maternal mortality.’ health in Canada and around the world. obstetric wing the ‘Lalonde Birthing Unit’. Global review presents key interventions for RMNCH The Partnership for Maternal, Newborn and Child Health (PMNCH), together with WHO, Aga Khan University and other partners, have produced, following consultations with a broad range of experts, a consensus document: Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health (RMNCH). The document – the product of extensive research and consultation – can be accessed at: essential_interventions/en/index1.html The document provides information on key selected survival interventions that should be made available to women and children, as well as information on the type of professional health worker required for their delivery, key commodities required, and corresponding available guidelines. Its aim is to support policy makers and RMNCH advocates and programme implementers in the development of guidelines, policies and programmes to improve the health of women and children. International Federation of Gynecology and Obstetrics FIGO House President-Elect: Administrative Director: Waterloo Court Sabaratnam Arulkumaran (UK) Bryan Thomas 10 Theed Street Past-President: Readers are invited to send all comments, articles and London SE1 8ST, UK Dorothy Shaw (Canada) reports (by email to or on Tel: +44 20 7928 1166 disk) to the FIGO Secretariat no later than 20 October Fax: +44 20 7928 7099 Vice President: Takeshi Maruo (Japan) 2012 for the next issue. Email: Honorary Secretary: The views expressed in articles in the FIGO Newsletter The International Federation of Gynecology and are those of the authors and do not necessarily reflect Obstetrics is a UK Registered Charity (No 1113263; Ian Fraser (Australia) the official viewpoint of FIGO. Company No 5498067) registered in England and Honorary Treasurer: Wales. The Registered Office is shown above. Wolfgang Holzgreve (Switzerland) Produced and edited by the FIGO Secretariat © FIGO 2012. President: Chief Executive: Gamal Serour (Egypt) Hamid Rushwan International Federation of Gynecology and Obstetrics | August 2012 7
  8. 8. 10660:Layout 1 10/8/12 12:44 Page 8 FIGO IN THE FIELD… Latest from the LOGIC Initiative Saving the lives of ESOG has implemented facility-based MDRs and administration of magnesium sulphate; and mothers through NMRs at eight public hospitals in four regions of better adherence to protocols and increased Ethiopia (Addis Ababa, Amhara, Oromia and availability of drugs. The hospital is also working facility-based SNNPR) since 2011. It has successfully been towards acquiring ambulance transport and Maternal Death working with the public health facilities to ensure setting up a ‘mini’ blood bank. and Near Miss staff ownership of the process. The fact that The successful implementation of MDRs/NMRs Reviews in hospital staff have not been reluctant to report requires strong partnership between the Ethiopia maternal deaths or near misses, nor have they Government, including the Federal Ministry of feared punitive action, is a credit to the Health (FMoH) and regional health authorities, The Ethiopian Society of successful management of the implementation of and other partners, including UN agencies and Obstetricians and Gynecologists MDRs/NMRs by ESOG. The data has been major bilateral donors. ESOG has throughout this (ESOG) has – through the support of the FIGO collected by multi-disciplinary hospital process been working very closely with the LOGIC Initiative (Leadership in Obstetrics & committees by using structured and standard Ethiopian Government as well as other partners. Gynaecology for Impact and Change) in Maternal MDR/NMR tools. The near-miss definition was and Newborn Health (MNH) – been working with Incorporating facility-based MDRs/NMRs into the based on validated disease-specific criteria. the Ethiopian Government and other partners to routine national maternal health programme is introduce facility-based Maternal Death Reviews ESOG has conducted primary analysis of key in finding out the causes and circumstances (MDRs) and Near Miss Reviews (NMRs) in eight facility-based MDR/NMR data between May and surrounding maternal deaths and near misses, so public hospitals in Ethiopia. This has been done October 2011 from eight hospitals to find out the that improvements in care can be implemented - as part of national efforts in Ethiopia to achieve causes and circumstances surrounding maternal thereby preventing future deaths and disabilities. Millennium Development Goal 5 to improve mortality and morbidity. During this period there The FMoH is currently working to standardise the reproductive and maternal health. The maternal were 119 maternal deaths and 989 near miss ESOG-initiated MDR/NMR tools and practice mortality in Ethiopia is 676 per 100,000 live births cases out of a total of 9,712 women giving birth. with the aim to incorporate this into the routine (Ethiopian Demographic Health Survey 2011). This represents a maternal mortality rate of national programmes. 1318/100,000 live births. 1.2 per cent of the total This article was prepared with the assistance of It is possible to prevent most maternal deaths facility-based deliveries result in maternal deaths. Dr Yirgu Gebrehiwot, ESOG President, Birukkidus and disabilities with known and effective The ratio of maternal death to near miss is nearly Tekleselassie, Project Manager, FIGO-LOGIC interventions, but this requires the right kind of 1:9. Initiative in MNH, and Selamawit Kifle, ESOG information on why women are dying or facing lifelong disabilities. It is not enough to have The leading causes of maternal deaths and near General Manager. information on the overall levels of maternal misses were: preeclampsia/eclampsia (29 per 1 Lewis, Gwyneth, 2003. ‘Beyond the Numbers: reviewing maternal cent); obstetric haemorrhage (16 per cent); and deaths and complications to make pregnancy safer”, British Medical mortality and morbidity – health policy makers Bulletin 2003; 67: 27–37, The British Council, 2003. and practitioners need to understand the uterine rupture (13 per cent). Nearly 52.8 per cent underlying factors to be able to prevent future of deliveries were attended at home and phase I deaths and disabilities. delay (delay in decision to seek care) contributed A facility-based MDR is a ‘qualitative, in-depth to about 25 per cent of maternal deaths and near investigation of the causes of and circumstances misses in the health facilities. surrounding maternal deaths’ in health facilities, ESOG has also found that the MDRs/NMRs while a NMR is the ‘identification and assessment provide a good learning experience for staff if the of cases in which pregnant women survive reviews are done in a participatory manner, using obstetric complications’ (Lewis, 20031 p. 33). The a team approach. The MDRs/NMRs have lessons learned from MDRs/NMRs lead to resulted in change in clinical practice within the recommendations for improvements in care to health facilities. For example, as a result of the MDR Workshop, Addis Ababa, 23 June 2012: L–R (left hand prevent future deaths and disabilities. It is not a MDR/NMR process, the hospital at Debre Berhan table): Dr Segun Adeoye, Dr Fred Achem, Dr Chris process for handing out blame or shame, but has reported many improvements, including Agboghoroma; L–R (right-hand table): includes Professor Robert Leke, Dr Philip Nana, Dr Jolly Beyeza and Dr Daniel exists to identify and learn lessons to help ensure increased use of the partogram from 48 per cent Murokora that mothers are healthy in the future. to 85 per cent; increased and appropriate FIGO LOGIC support for MDRs and NMRs FIGO LOGIC, funded by the Bill & Melinda Gates Foundation, is working with eight FIGO Member Associations (MAs), internationally renowned Maternal Death Review (MDR) experts, and other partners to influence and improve the use of maternal death notification systems and/or MDRs in eight countries in Africa (Burkina Faso, Cameroon, Ethiopia, Mozambique, Nigeria and Uganda) and South Asia (India and Nepal). The FIGO MAs taking part in the FIGO LOGIC Initiative in Maternal and Newborn Health (MNH) are working closely with Ministries of Health, relevant health authorities, hospital management in David Taylor, FIGO LOGIC Project Director selected hospitals as well as other partners such as multilateral institutions to implement MDRs, and in some cases Near Miss Reviews (NMRs) and Maternal and Perinatal Death Reviews (MPDRs). The aim is to implement MDRs/NMRs in line with international standards and as outlined in the World Health Organization publication: ‘Beyond the Numbers – Reviewing maternal deaths and complications to make pregnancy safer’ (2004). FIGO LOGIC is working towards contributing to nationally, sustainable MDR/NMR processes over the longer-term with the aim of helping to improve maternal health services and preventing future maternal deaths and disabilities. Gynecologists and obstetricians, together with other health care professionals, have an important Dr Yirgu Gebrehiwot, ESOG President role to play in improving MNH policy and clinical practice, including through the implementation of findings and recommendations coming out of MDR and NMR processes. The following FIGO MAs are participating in the FIGO LOGIC Initiative in Maternal and Newborn Health: Société des Gynécologues et Obstétriciens du Burkina Faso (SOGOB); Society of Gynaecologists and Obstetricians of Cameroon (SOGOC); Ethiopian Society of Obstetricians and Gynecologists (ESOG); The Federation of Obstetric and Gynaecological Societies of India (FOGSI); Associação Moçambicana de Obstetras e Ginecologistas (AMOG); Nepal Society of Obstetricians and Gynaecologists (NESOG); Society of Gynaecology and Obstetrics of Nigeria (SOGON); Association of Obstetricians and Gynaecologists of Uganda (AOGU). Birukkidus Tekleselassie, Project Manager (ESOG), FIGO-LOGIC Initiative in MNH 8 International Federation of Gynecology and Obstetrics | August 2012