FIGO prepares for globalgathering@Rome 2012

In ternat iona l Federat ion of Gynecology and Obstet r ics | August 2012 1

World Congress countdown | Executive Board meets in Beijing | Gynuity’sBeverly Winikoff | Dr André Lalonde reviews SMN Initiative | Latest from LOGIC

continued on page 2

International Federation ofGynecology and ObstetricsFFIIGGOOFIGO

INSIDE:

communications@figo.orgwww.figo.org August 2012

Dear ColleaguesSince our last communication in March, it hasbeen an extremely busy time for FIGO!

We have been accelerating our efforts to finalisearrangements for the FIGO XX World Congress inRome, from 7 to 12 October 2012.

The Scientific Programme Committee hasperformed a wonderful job in compiling anexceptionally strong programme incorporatingbasic- to cutting-edge knowledge in women’shealth. The agenda also involves toprepresentatives of UN organisations, NGOs,sister professional organisations andpolicymakers as our collaborative efforts areessential to achieving the health-relatedMillennium Development Goals (MDGs). TheCongress Organising Committee has beenworking hard to ensure the comfort of allattendees, and easy transportation to the

Congress venue (on registration, participants willreceive a free travel card for use on publictransport to be utilised throughout the Congress).The social and cultural programmes areoutstanding and include a Papal Audience onWednesday 10 October. The Local OrganisingCommittee is sponsoring 30 Fellowships foryoung colleagues from developing countries in

Centres of Excellence in Italy, and it is alsohosting seven Pre-Congress educational andtraining courses in Italian hospitals.

I am highly encouraged by the enthusiasm ofthousands of my colleagues from all over theworld who have already registered for thisCongress. Please do join us for what promises tobe one of the most memorable ever, and duringwhich we shall celebrate launching the newAfrican Federation of Obstetrics and Gynecology(AFOG). I would like to thank the World HealthOrganization’s (WHO) Regional Office for Africafor its staunch support of this forthcomingenterprise.

FIGO leading the way in globaleducation and trainingWith rapid developments in science andtechnology, and the evolution of evidence-basedand person-centered management of variouswomen’s health conditions, it is essential tostrengthen our education and trainingprogrammes to enable the passing on ofknowledge and skills to ‘grassroots’ obstetriciansand gynecologists in remote rural areas. SinceOctober 2009, our Committee for CapacityBuilding in Education and Training has conductedmore than 54 sessions and workshops aroundthe globe, particularly in developing countries.For example, an outstanding hands-on workshop

The FIGO President, with other participants, at a private Papal audience, on the occasion of the ‘Management of InfertilityToday’ Workshop, Vatican City (February 2012)

Members of the Executive Board participating in aneducational seminar, Beijing (May 2012)

The FIGO President delivering his address at the ExecutiveBoard dinner with Chinese officials

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FIGO prepares for global gathering@Rome 2012Continued from page 1

In ternat iona l Federat ion of Gynecology and Obstet r ics | August 20122

(one of a series) on ‘Ultrasound and BasicSurgical Skills’ for 40 obstetricians and 30midwives was organised in Burkina Faso byProfessor Eric Jauniaux, in collaboration with theSocieté de Gynécologues et Obstétriciens duBurkina (SOGOB).

Following on from the success of the hands-onworkshop on Minimally Invasive Surgery (MIS),held in Khartoum last February, a further courseis scheduled there from 17–20 September 2012,while another is planned for the Ukraine. Thanksare due to Olympus Surgical TechnologiesEurope for its robust support of this programme.

As Dr David Adamson (Chair of the FIGOCommittee for Reproductive Medicine) andmyself were very encouraged with the greatsuccess of three workshops on ‘A Basic andAdvanced Clinical and Laboratory TrainingCourse in Infertility, including ART for DevelopingCountries’, a fourth workshop is planned incollaboration with the International Islamic Centerfor Population Studies and Research (IICPSR), AlAzhar University, from 8–12 December 2012.Many thanks to IBSA International for its supportof these Committee activities.

The Executive Board endorsed the TrainingCurriculum on Bioethics in Human Reproductionand Women’s Health for Developing Countries,developed by the FIGO Committee for EthicalAspects of Human Reproduction and Women'sHealth. This Curriculum will be a tremendous helpfor developing countries both in pre-service andin in-service training of healthcare professionals. Isincerely thank Ford Foundation for its support ofthis project.

The FIGO Fistula Initiative – ensuring high qualityclinical training for the care of women withobstetric fistula – is progressing well.Accreditation for training centres has taken placeand training centres are now identified (seeProfessor Rushwan’s report on page three).Thanks are due to the United Nations PopulationFund (UNFPA), and a host of other high profilepartners.

MDG 2015 Countdown andFIGO global partnershipsFIGO has joined forces in global efforts toaccelerate progress to achieve the health-relatedMillennium Development Goals. On invitationfrom the Director of WHO’s RHR/HRP, Iparticipated in the 29th Scientific and TechnicalAdvisory Group (STAG) meeting held in Genevain February. Discussions mainly centred on thestrategic direction of the department and theHRP research breakthroughs contributing tosaving women’s and children lives.

In February, I participated in a special workshop,‘The Management of Infertility Today’, organisedby the Pontifical Academy for Life, the Vatican,Italy, delivering a lecture on ‘The Global ChangingPrevalence of Infertility’, and its impact onpopulation policy and family planning. Thehighlight of the visit was a private PapalAudience.

In May I participated in the 5th InternationalParliamentarians’ Conference on theImplementation of the International Conferenceon Population and Development (ICPD)Programme of Action, in Istanbul, organised byUNFPA and the European Parliamentary Forumon Population and Development (EPF). Ipresented in the first plenary session of theconference a lecture on ‘Scaling up Strategies toReduce Maternal Deaths: Achievements andPersistent Challenges’.

In June, I held a meeting with UNFPA’s DeputyExecutive Director (Programme) and theAssistant UN Secretary-General Dr Kate Gilmoreduring her exploratory visit to Africa. I discussedwith her how best we can utilise Faith-BasedOrganisations for the implementation of ICPD’sPoA, and achieving the health-related MDGs, andshared IICPSR’s experience at national, regionaland international levels.

Also that month, FIGO joined the PopulationCouncil and Reproductive Health SuppliesCoalition (RHSC) and held a meeting on Long-Acting, Reversible Contraception (LARC) inBellagio. The group produced a statement whichwas submitted to a special London Summitmeeting – which I attended – organised in July bythe UK Government, the Bill & Melinda GatesFoundation and UNFPA. Many Presidents, FirstLadies, Ministers and leaders from UNorganisations and NGOs attended. A videomessage was sent from Hillary Clinton, and anaddress given by UK Prime Minister DavidCameron. The meeting was extremelysuccessful, with pledged commitments of 2.6billion US dollars from donor governments andother partners, and 2 billion US dollars fromdeveloping countries, to provide for the unmetneed for contraception for 120 million womenand girls in developing countries by 2020. Shortlyafter this Summit, FIGO met with the PopulationCouncil and the RHSC to discuss how best toutilise the statement to improve access to LARC.

Strengthening collaboration withmember and regional societiesOver the past few months I have participated in alarge number of regional and national societymeetings, delivering presentations, chairingsessions and workshops and holding meetingsand discussions with key society representatives.

These included:• 64th JSOG Annual Congress (JapaneseSociety of Obstetrics and Gynecology), Kobe,

Japan (April 2012): I met with the JSOGleadership and the Japanese InternationalCooperation Agency (JICA) to discuss theinvolvement of Japan in FIGO’s global women’shealth activities. FIGO will develop a conceptproposal to take this initiative forward.

• 60th ACOG Annual Clinical Meeting (AmericanCollege of Obstetricians and Gynecologists),San Diego, USA (May 2012): I discussed withACOG’s leadership its support of FIGO’sCongress, and the progress of its initiative onglobal maternal health with FIGO, the RoyalCollege of Obstetricians and Gynaecologists(RCOG) and the Society of Obstetricians andGynaecologists of Canada (SOGC).

• 38th NFOG Congress (Nordic Federation ofSocieties of Obstetrics and Gynecology),Bergen, Norway (June 2012): I delivered alecture on ‘Ethics in Human Reproduction andWomen’s Health’. I discussed with ProfessorKnut Hordnes, Congress President, and DrGoran Berg, NFOG President, strengtheningcollaboration and coordination between FIGOand NFOG in developing countries where FIGOand NFOG both have ongoing progress.

• 68th SOGC Annual Clinical Meeting, Ottawa,Canada (June 2012): This presented a specialopportunity to discuss strengtheningcollaboration between FIGO and the SOGC inthe light of the new SOGC leadership, and alsothe selection of Vancouver as the site of the2015 Congress. The highlight of this meetingwas attending the Council and the PastPresidents’ dinner where I was awarded theHonorary SOGC Fellowship. I am immenselyproud to be recognised in this way, and amgrateful to the SOGC Council for bestowingthis great honour.

Our thanks to China:Executive Board 2012Our 72nd Executive Board meeting was held inBeijing, China, in May 2012. It was a superblyorganised event, and it well reflected that FIGO’srelationship with its member societies is gettingstronger and stronger. In fact, we have alreadyreceived requests to host the 2013 meeting fromseveral member societies. I know that both FIGOstaff and Board members were overwhelmed bythe great hospitality and warmth of our Chinesecolleagues, and their excellent organisation. I amextremely grateful to the Chinese Governmentand the Chinese Society of Obstetrics andGynecology (CSOG) for their kindness and theircommitment to the overall success of thisimportant annual event.

Colleagues and friends: as I end this message,there is still a great deal for FIGO to accomplishbefore the start of the Congress. I am very muchlooking forward to welcoming you all to what Iknow will be one of the most memorable FIGOCongresses since the start of its history.

I wish you a productive summer and safe travelsto Rome.

Best wishes

FIGO President Gamal Serour

The FIGO Executive Board visiting the Beijing Obstetricsand Gynecology Hospital

Burkina Faso Workshop

64th JSOG Annual Congress (Japanese Society ofObstetrics and Gynecology), Kobe, Japan (April 2012)

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CHIEF EXECUTIVE’S OVERVIEW

In ternat iona l Federat ion of Gynecology and Obstet r ics | August 2012 3

FIGO@Rome 2012: The place to beDear Colleagues

By the time you receivethis summer edition ofthe Newsletter, the XXFIGO World Congresswill be just a few shortweeks away. Thevarious organisingCommittees are puttingthe finishing touches towhat will be a mosttremendous event. Ifyou have not already

done so, please secure your registration athttp://www.figo2012.org/registration to avoiddisappointment. This triennial FIGO event is theculmination of three years’ exceptional hard workand planning, and we are thrilled that so many ofour global colleagues are set to join us. Morenews about the Congress can be found on page10.

Meetings and travels have been extremely brisksince my last reporting. In early March, I attendeda Technical Consultation on the World HealthOrganization (WHO) Recommendations on Post-Partum Haemorrhage, in Montreux. The meetingwas held to review available evidence and updatethe global recommendations on prevention andmanagement of post-partum haemorrhage (PPH)– the leading cause of maternal mortality – and itaddressed major issues both for women whogive birth in a medical setting and for those whodeliver at home. The WHO and stakeholders aredeveloping a new set of guidelines on theprevention and treatment of PPH, based on newscientific evidence, and this will be circulated tostakeholders for endorsement.

Conference – held in partnership with theObstetrical and Gynaecological Society ofMalaysia (OGSM) – where I chaired a FIGO-sponsored session: Misoprostol for theprevention and treatment of post-partumhaemorrhage: From clinical evidence tooperational realities (see our update on FIGO’smisoprostol initiative on page nine).

Shortly afterwards, I flew to Washington toparticipate in two important meetings: the ‘ChildSurvival Call to Action’ organised by the UnitedNations Children’s Fund (UNICEF) and the UnitedStates Agency for International Development(USAID), and a preceding briefing/consultationmeeting on Countdown to 2015 combined with acivil society forum about the ‘Call to Action’,organised by Save the Children.

At June-end, I travelled to the WHO in Geneva torepresent FIGO at the 25th Meeting of the Policyand Coordination Committee (PCC),Development and Research Training in HumanReproduction (HRP) – theUNDP/UNFPA/WHO/World Bank SpecialProgramme of Research. This meeting coincidedwith the 40th Anniversary Celebration of the HRP.

Olympus and FIGO join forces on MISI am extremely pleased to report that the firstFIGO-Olympus Workshop on Minimally InvasiveSurgery (MIS) – organised in conjunction with theObstetrical and Gynaecological Society of theSudan – was successfully conducted at SobaUniversity Hospital, Khartoum, Sudan, at the endof February. This is as a result of a newcollaboration recently agreed with OlympusSurgical Technologies Europe, which issponsoring the establishment of three FIGOtraining centres in Africa, East Europe andpossibly Latin America, as well as the traineesand trainers.

This highly successful Workshop set the optimumstandards for future events, and the secondcourse will run from 17–20 September 2012.FIGO would like to extend its gratitude to theObstetrical and Gynaecological Society of theSudan for its robust efforts in helping thecollaboration to achieve its goals.

The first course for MIS in Kiev, the Ukraine, isplanned for September 2012. Details will beavailable soon on www.figo.orgI wish you all safe travels to Rome, and a highlyenjoyable and successful few days at theCongress. Thank you for supporting FIGO’s goodwork.

Best wishes

FIGO Chief ExecutiveHamid Rushwan

Training Initiative using FIGO’s Training Manual,and a course for the Training of Trainers will beconducted in Addis in the very near future. TheHamlin Fistula Hospital will provide an excellenttraining facility for the FIGO Initiative.

In Tanzania, we visited the ComprehensiveCommunity Based Rehabilitation Tanzania(CCBRT), a well recognised hospital with animpressive track record of fistula activity. Twoexperienced surgeons are ready to participate inthe Training Initiative, utilising the manual, andFellowships are being finalised for training eighttrainers and a selection of trainees.

The last site we visited was in Arusha, where DrAndrew Browning provides general obstetricaland gynecological services in a new hospital.There are only a few fistula cases being treatedhere, and therefore the centre is not able toaccommodate or provide training. However it isanticipated that training will be conducted inArusha on an ad-hoc basis, depending on thecaseload for trainees.

FIGO Chief Executive,Hamid Rushwan

WHO PPH meeting (Montreux)

Dr Catherine Hamlin with Chief Executive Hamid Rushwanand Lord Naren Patel

L–R (Gondar Fistula Centre): Fistula surgery trainee (fromBangladesh); nurse; Dr Ambaye Wolde Michael; ProfessorHamid Rushwan; Dr Mulu Muleta; nurse; Lord Naren Patel

Executive Board in session

PhotocourtesyoftheMCHIPProgram

Fistula site visits set the scene foraccreditationAt April-end, I travelled to Ethiopia and Tanzaniawith Lord Patel, Chair of the FIGO Committee forFistula, to carry out site accreditation visits aspart of the planned implementation of thestructured fistula surgery training programmeusing the Global Competency-Based FistulaSurgery Training Manual, developed by FIGO andpartners.

Four centres were visited. In Ethiopia, the GondarFistula Centre (65-bedded), directed by Dr MuluMuleta and Dr Ambaye Wolde Michael, was wellequipped, but needs transportation to bring morepatients from the surrounding rural areas, as wellas additional equipment. In Gondar we met witha physician who had travelled from Bangladeshto begin six weeks’ training in fistula surgery. Heis part of a FIGO-organised training programmethat aims to increase the global number ofphysicians trained to provide treatment forwomen living with fistula.

We also visited the Addis Ababa Fistula Hospital,run under the guidance of Dr Catherine Hamlin.This hospital is very well established, with sixsatellite centres, and it has a large caseload. Thedoctors are extremely committed to the FIGO

FIGO held its annual Executive Board meeting inBeijing, in May, and I would like to take thisopportunity to thank once again the ChineseSociety of Obstetrics and Gynecology (CSOG) forits superb organisation of this important event (afull report is on page five). We received greathospitality from our Chinese hosts, and specialmention must go to President Dr Jinghe Lang,and Former President Dr Zeyi Cao.

Keeping our global momentumIn June – a hectic month – I travelled to Kuching,Malaysia, for the Royal College of Obstetriciansand Gynaecologists’ (RCOG) 10th Annual

Beijing press conference

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After almost 30years of work onReproductive Healthbased in largeorganisations,Dr Beverly Winikoffopened the doorsof Gynuity HealthProjects in2003. Gynuity(www.gynuity.org), asit is more commonlyknown, is a smallresearch and technical

assistance organisation with an energetic 30-strong staff base, most of whom are publichealth professionals.

models of research and implementation,emphasising ways in which existing medicinesand health technologies could be provided in amore woman-centred fashion and made moreavailable and acceptable.

Dr Winikoff, how did Gynuity’srelationship with FIGO evolve?Gynuity and FIGO have an extensive history ofcollaboration on several special initiatives aimedat addressing principal causes of maternalmortality, including post-partum haemorrhage(PPH). Over the years, we have joined forces tohelp translate key findings of clinical research(implemented by Gynuity and other internationalagencies) into policy guidance and clinicalprotocols. FIGO, along with other internationalagencies, has joined a five-year initiative led byGynuity [see page nine] with the aim of translatinga large and growing body of scientific evidenceon misoprostol for PPH into operational reality, sothat all women will have access to a uterotonicfor the prevention and/or treatment of PPH.

The initiative, funded by the Bill & Melinda GatesFoundation, encompasses a range of scientific,operational and policy issues related to the use ofmisoprostol for PPH care. As a part of thiscollaborative effort, FIGO plays a critical role inadvocacy for and dissemination of evidence-based information for providers and clinicalpolicymakers. Its member societies continue tobe instrumental in setting and advancing thestandards of PPH care locally, including theintegration of evidence- based norms on the useof misoprostol.

How do you see Gynuity’s work withFIGO progressing in the future?As part of the ongoing collaboration, thedissemination of new evidence on misoprostol inPPH management to providers is being facilitatedby FIGO via a number of expert panels plannedand implemented at national, regional andinternational meetings, including the 2012 FIGOWorld Congress in Rome where a half-daysession is planned. New materials, includingtraining tools, protocols and guidelines on theuse of misoprostol in PPH management, are alsoforthcoming in several languages. To highlightnew research and its implications as findingsbecome available, a number of peer-reviewedscientific articles and special publications will alsoappear in FIGO’s specialist global publication, theInternational Journal of Gynecology & Obstetrics(IJGO).

Our project on misoprostol has allowed us toask, and try to answer, such provocativequestions as:• How can we use the potential of misoprostolfor treatment as well as for prevention of PPH?

• Since some women will develop excessivepost-partum bleeding no matter whatprophylactic they are given, how can weencourage health systems to plan treatmentstrategies at the same time as they are beingurged to develop prevention programmes?

• Can misoprostol be used for both preventionand treatment in the same woman?

• Is it easier and more cost-effective to useoxytocin in Uniject or misoprostol for preventionin community-based programmes?

• Can women be given misoprostol toself-administer for prevention of PPH in homebirths?

What do you find most satisfyingand challenging about your work?It is extremely gratifying to see the blossoming ofcollaborations and to be able to join with like-minded colleagues in projects that createchange. An exhilarating part of Gynuity’s work isthe opportunity to follow creative leads inresearch on women’s health. We push ourselvesto look for new ways to provide services and newtechnologies to incorporate in them. We aim todevelop safe and effective, affordable, acceptabletechnologies that are delivered in a woman-friendly way, and enhance the autonomy andwell-being of each person.

Our collaboration with FIGO is particularlyprecious to us for its potential to have real impacton women’s lives. By mustering the power of theob/gyn community in support of new ways toattend to women having babies, especially in thepoorest and most underserved areas of theworld, our research becomes meaningful. We arevery grateful for the opportunity.

For more information on Gynuity’s activities, visitwww.gynuity.org

IJGO: from strength to strength in 2012FIGO’s official publication, theInternational Journal of Gynecology& Obstetrics (IJGO), has continuedits success over the past 12months and is experiencing aparticularly busy year in 2012.

Clare Addington, IJGO ManagingEditor, said: ‘The most recent ImpactFactor, for 2011, 2.045, is its highestto date, and in 2011 the journalreceived 1323 submissions. The2011 acceptance rate is predicted tobe 22 per cent and the Journalcontinues to increase the annualnumber of reviewers (702 in 2011)and the geographic representation ofthose contributing reviews.’

The annual meeting of the IJGO Editorial Board was convened in London in February 2012 andwas attended by its Editor – Dr Timothy Johnson – Associate Editors, and members of the Editorial

Office. The meeting reviewed the content of the FIGO 2012 World Reporton Women’s Health, which will be guest edited by FIGO’s President-Elect, Professor Sir Sabaratnam Arulkumaran, and will be published intime for the FIGO 2012 Congress in Rome. The Report comprises 20articles under the challenging topic of ‘Improving Women’s Health’, andcontains contributions from, among others, authors from FIGO’sCommittees, project teams, and collaborating organisations.

Clare added: ‘A particular focus of the Editorial Board Meeting was thedevelopment of the IJGO website – www.ijgo.org – and opportunitiesfor implementation of new technologies for reader interaction, such asvideo hosting.’

At the FIGO Congress in Rome, IJGO will host an author workshopentitled ‘An Insider's 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 howto maximize their chances of getting their research published – from understanding the submissionprocess and article requirements, to tips from the Editor about what the Journal is looking for andfrom 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 anonline book of the abstracts presented at the FIGO Congress.

Clare ended: ‘In April, we welcomed Helen Metherell as a new Editorial Assistant. We are delightedto have her on board and look forward to a productive second half of 2012.’

PEOPLE

4

Q and A with Beverly Winikoff, MD, MPH (President of Gynuity Health Projects)

Beverly Winikoff, MD, MPH,President of Gynuity HealthProjects

Gynuity is dedicated to the idea that all peopleshould have access to the fruits of medicalscience and technology, and it works globally toensure that reproductive health technologies arewidely available at reasonable cost, provided inthe context of high-quality services, and offeredin a way that recognises the dignity andautonomy of each individual. Efforts are focusedparticularly on resource-poor environments,underserved populations, and challengingsubject matter. Dr Winikoff saw in a smallorganisation the opportunity to create flexible

In ternat iona l Federat ion of Gynecology and Obstet r ics | August 2012

IJGO Editorial Board Meeting in progress (London, February 2012)

Dr Timothy R B Johnson,IJGO Editor

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In ternat iona l Federat ion of Gynecology and Obstet r ics | August 2012 5

Beijing welcomes FIGO for 2012Executive Board MeetingThe 2012 FIGO Executive Board Meeting washeld at the Crowne Plaza Park View WuzhouBeijing Hotel, Beijing, China in May 2012, inconjunction with the Chinese Society ofObstetrics and Gynecology (CSOG) andsupported by the Beijing Royal IntegrativeMedicine Hospital.

Chief Executive Hamid Rushwan said: ‘FIGOwould like to thank its Chinese hosts – mostespecially CSOG’s President Dr Jinghe Lang, andFormer President Dr Zeyi Cao – for a superblyorganised meeting and the accompanyingexcellent hospitality which was greatlyappreciated. The event was a valuableopportunity for FIGO officials to “touch base” withour esteemed Chinese colleagues, and tofamiliarise ourselves with current obstetrical andgynecological issues in this fascinating part of theworld.

‘Thanks are also due to the FIGO Secretariat staff– Bryan Thomas and Marie-Christine Szatybelko– for their usual excellent handling of all BoardMeeting arrangements.’

encompassed the broad spectrum of globalwomen’s health issues, outlining FIGO’s activitiesin various countries. These activities formed thebasis of the seminars’ educational topics,drawing on the rich experience of ourCommittees and Working Groups.

‘Lecture topics included maternal mortality, post-partum haemorrhage, unsafe abortion, obstetricfistula, cancer prevention, ethics problems andwomen’s sexual rights, and speakers comprisedthe Chairs of FIGO’s Committees and WorkingGroups, as well as Board Members.

‘It is always important that the host country playsa vibrant and significant role in the developmentof these popular seminars, so the programme istraditionally completed with the contribution of itsspeakers and topics. China focused on its issuesof maternal mortality, early diagnosis of cancer,and preservation of fertility.’

seminars, and to CSOG for its tremendouscontribution in helping us to run the events sosmoothly and successfully.’

Seeing the Chinese pictureA briefing session on the state of women’s healthin China and, in particular, maternal and newbornhealth, was held during the trip. Representativesof CSOG, the Ministry of Health and a number ofinternational organisations were invited to presentan overview of women’s health to the ExecutiveBoard meeting participants.

Executive Board 2012

Executive Board in session

FIGO Administrative Director Bryan Thomas (left) andFIGO Senior Administrator and Committee ManagerMarie-Christine Szatybelko with colleague YonggangShang

A number of valuable related activities took placealongside the main Executive Board business:

Women’s Health:Contemporary ChallengesThe FIGO Committee for Capacity Building inEducation and Training organises the nowtraditional educational seminar during the periodof the Executive Board Meeting. In China, twoevents were held, one in Beijing and one inChengdu, under a common theme: Women’sHealth: Contemporary Challenges.

Professor Luis Cabero-Roura, Committee Chair,explained: ‘The seminar programme – startingwith a lecture from the FIGO President –

FIGO seminar speakers in Chengdu

Seminar participants

President Gamal Serour (right) with CSOG’s FormerPresident Dr Zeyi Cao

He added: ‘We are pleased to report thatattendance was superb – more than 700students in Beijing and 300 in Chengdu – withplenty of discussion and participation amongboth students and speakers. We performed thesame anonymous multiple choice test questionsbefore and after the seminar, and the results weresimilar in both: a 40 per cent increase in correctanswers, which truly reflected the positive impactof these events.’

He ended: ‘FIGO – in particular, the Committeefor Capacity Building in Education and Training –wishes to express its sincere gratitude to thespeakers who generously participated in the

FIGO field visit: focus on BeijingObstetrics and Gynecology HospitalA visit to the well-regarded Beijing Obstetrics andGynecology Hospital took place during the trip:founded in 1959, it is the largest obstetrics andgynecology hospital in Beijing, and highlyadvanced in perinatology and women’sreproductive health. It is also notable for servingas a World Health Organization (WHO) researchand training centre for women’s health in China.

FIGO President Gamal Serour with the Minister of Health

Chief Executive Professor Hamid Rushwan (right) withhospital staff

FIGO President-Elect Professor Sir SabaratnamArulkumaran (centre) views facilities

Chief Executive Hamid Rushwan commented:‘This valuable visit provided FIGO with anexcellent overview of the state of currentmaternal and newborn healthcare in China.

‘It was clear from our tour of the hospital thatmedical professionals have been trained torigorous standards: we were greatly impressedwith their calibre and dedication, and thesubsequent high quality robust care provided tomothers and babies.’

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In ternat iona l Federat ion of Gynecology and Obstet r ics | August 20126

Looking back; moving forward(2006–2011, funded by the Swedish International Development Cooperation Agency – www.sida.se – and FIGO)

SAVING MOTHERS AND NEWBORNS INITIATIVE

FIGO’s recently concluded Saving Mothers andNewborns Initiative resulted in great challengesand opportunities for low- and middle-resourcecountries in their quest to make a tangibledifference in the reduction of maternal andnewborn morbidity and mortality, and to theachievement of MDG goals 4 and 5,’ said DrAndré Lalonde, Project Director, and Chair ofthe FIGO Committee for Safe Motherhood andNewborn Health.

objectives: to strengthen the capacity of nationalprofessional associations to engage in maternaland newborn health through the design andimplementation of projects, and to strengthen co-operation between FIGO and national societies,and between societies in regions of differingeconomic levels.

‘Further secondary aims were to strengthen theco-operation between national societies and thenational stakeholders involved in safemotherhood and newborn health, and toincrease the credibility of national societies locallyto provide technical support to Ministries ofHealth (MoH) and national professional councils.

‘Each project focused on identified needs withineach country and resulted in varied approachesand targets, ranging from clinical training,protocol development, and implementation ofclinical audit through to legislative and policychange.’

Rising to the challengeDr Lalonde explained: ‘From the very start, thechallenges were immense, but the project elicitedtremendous enthusiasm in reacting to the needsof pregnant women in the countries involved.

‘Some concrete examples of success: theUruguay project – how to manage unsafeabortion in a country with very restrictive laws – isa model for many countries. The Haiti projectresponded to an enormous humanitarian disaster[a severe earthquake] through making the projectmaternity centre one of the few maternities inPort au Prince able to offer essential obstetrical

care, thus preventing hundreds of maternaldeaths. The Kenya project instituted clinicalaudits and mobilised the healthcare professionals(HCPs) to provide better care. The Pakistanproject recruited and trained local women toprovide essential obstetrical care.

‘Each project was indeed unique and, despitepresenting huge administrative challenges,succeeded in mobilising HCPs – for many, thiswas the first time that there had been a directresponse to the needs of safe motherhood andnewborn care in their countries outside of theirclinical practices.

A significant outcome‘We are delighted to report that significant andlargely sustainable results were achieved,particularly in relation to the relatively small-scalefunding available, and this resulted in directimprovements to maternal and newborn healthoutcomes. The capacity of both FIGO andnational professional associations was alsosubstantially strengthened in project design,management, and implementation, leading toopportunities to support internationaldevelopment efforts in the future.

‘One of the most notable achievements was theprovision of clinical training to more than 2,000health professionals, including traditional birthattendants, midwives, doctors, and obstetricians.

‘The SMNH Committee played no small part inthe success of this enterprise – Committeemembers in different regions were tasked withtroubleshooting difficulties, therefore providing acost-effective solution to problem-solving.’

Dr Lalonde concluded: ‘All programme directorsare scheduled to present their results at a half-day seminar at the FIGO World Congress, and abooklet will also be produced and made availableon www.figo.org’Full reports on the project’s activities (includingthe individual country reports) are available onthis section of the FIGO website:http://www.figo.org/projects/newborns

The project in focusSelected achievementsHaiti ‘Strengthening the health center of Croix des Bouquets’ Primary health clinic transformed intofunctioning hospital; ambulance purchased and on-call driver contracted

Kenya ‘Improving quality of prenatal, delivery, and postnatal care through clinical audit’ Update ofclinical audit extended beyond maternity into general surgery

Kosovo ‘Reduction of maternal and newborn mortality’ First set of national standards developedby a clinical body produced by national association and approved by the MoH

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’ Magnesiumsulphate supplied to all state hospitals by Kaduna State Government; its cost reduced bymanufacturers

Pakistan ‘Community-based interventions to reduce maternal and perinatal mortality and morbidityin 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) inrural mountain area audits

Uganda ‘Reduction of maternal and newborn mortality’ Paradigm shift in professionalorganisational thinking led to collaborative working with non-health community staff to achieveimproved health outcomes for rural women

Ukraine ‘EmOC improvement by advances in labor and risk management (ALARM) internationalprogram (AIP)’ Reduction in inappropriate clinical interventions during delivery

Uruguay ‘To protect the life and health of Uruguayan women by reducing unsafe abortions’ Policyand legislative change; Presidential support for the project; creation of a sexual and reproductivehealth department within the MoH (headed by project director)

L–R: Dr André Lalonde, Chair FIGO SMNH Committee; MrJosé Mujica, President Of Uruguay; Economist DanielOlesker, Minister of Health; Leonel Briozzo, director ofproject, Sub Secretario de Salud Pública

Women and children, Uganda

Explaining the challenges (Kenya project)

Pakistan medical camp

Laying the groundworkHe continued: ‘The Committee worked withassociations of obstetricians, gynecologists andmidwives in 10 low- and middle-resourcecountries between 2006 and 2011, withcontributions from professional associations inhigh-resource countries through a structurednorth-south mentoring programme.

‘The countries involved were: Haiti, Kenya,Kosovo, Moldova, Nigeria, Pakistan, Peru,Uganda, Ukraine and Uruguay.

‘The main goal - that of contributing to thereduction of maternal and newborn morbidity andmortality to help achieve MDGs 4 and 5 – wascomplemented by critically important secondary

Peru training

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Dr André Lalondereceives QueenElizabeth II Jubileemedal

7In ternat iona l Federat ion of Gynecology and Obstet r ics | August 2012

FIGO Chair highlightsimportance of new PPHGuidelinesFor many years, Dr Lalonde has beenactive in FIGO’s worldwide campaign toprevent PPH, promoting non-invasivetreatments to prevent this devastatingcondition.

He commented: ‘The FIGO Committee forSafe Motherhood and Newborn Health hascompleted a full review of the physiology ofthe Third Stage of Labour, and preventionand management of PPH in low-resourcecountries. FIGO’s recently publishedGuidelines [available athttp://www.figo.org/publications/PPH_Guidelines], in the International Journal ofGynecology & Obstetrics, are not onlyevidence-based, but include importantclinical information to help all healthcareprofessionals to tackle this huge problem.’

He added: ‘The central recommendation isthat all women should be offered an oxytocicdrug at delivery. It also calls for communityavailability of trained personnel in midwiferycare, as well as supply of misoprostol [seepage 9] where oxytocin is not available.

‘In particular, there are discussions on thecascade of medical and surgical treatment ofPPH, and recommendations on the use ofuterine tamponade and the anti-shockgarment [NSAG].

‘The Guidelines offer a logical approach, anddownloadable schemas that can bereproduced and used as posters in deliveryrooms.’

He ended: ‘Medical societies shouldpressure all governments to supplynecessary drugs and equipment to preventand treat PPH, and therefore help to reducematernal mortality.’

Global review presents key interventions for RMNCHThe Partnership for Maternal,Newborn and Child Health (PMNCH),together with WHO, Aga KhanUniversity and other partners, haveproduced, following consultations witha broad range of experts, a consensusdocument: 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:http://www.who.int/pmnch/topics/part_publications/201112_essential_interventions/en/index1.htmlThe document provides information on key selected survival interventions that should be madeavailable to women and children, as well as information on the type of professional health workerrequired for their delivery, key commodities required, and corresponding available guidelines.

Its aim is to support policy makers and RMNCH advocates and programme implementers in thedevelopment of guidelines, policies and programmes to improve the health of women and children.

On 21 June 2012 Dr André Lalonde, Chair ofthe FIGO Committee for Safe Motherhood andNewborn Health, received the Queen ElizabethII Jubilee Medal for his contribution to women’shealth in Canada and around the world.

Dr Lalonde continues his commitment toreducing maternal mortality in low-resourcecountries and especially the prevention andtreatment of post-partum haemorrhage (PPH).More recently, he led the Committee indeveloping FIGO PPH Guidelines.

He is seen below with the Minister of InternationalCooperation, Ms Beverley J Oda, at a ceremonyin Ottawa. She complimented Dr Lalonde on hisillustrious career and on how he ‘makes Canadaproud’.

A selection of Dr Lalonde’sachievements:• Leading the ground-breaking multi-disciplinaryCollaborative Primary Maternity Care Project.This enabled nurses, midwives, familyphysicians and obstetricians to work togethereffectively to ensure appropriate care.

• Pioneering a worldwide Maternal RiskManagement programme to address maternaland newborn mortality and morbidity. TheALARM International programme has beenpiloted and used in over 20 low-resourcecountries with great success.

• Co-authoring Postpartum HemorrhageToday, the definitive textbook on the subject.

• The LaSalle General Hospital in Montreal,where Dr Lalonde was Head of Obstetrics,recognised his dedication and named theobstetric wing the ‘Lalonde Birthing Unit’.

FIGO HouseWaterloo Court10 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:Gamal Serour (Egypt)

President-Elect:Sabaratnam Arulkumaran (UK)

Past-President:Dorothy Shaw (Canada)

Vice President:Takeshi Maruo (Japan)

Honorary Secretary:Ian Fraser (Australia)

Honorary Treasurer:Wolfgang Holzgreve (Switzerland)

Chief Executive:Hamid Rushwan

Administrative Director:Bryan Thomas

Readers are invited to send all comments, articles andreports (by email to communications@figo.org or ondisk) to the FIGO Secretariat no later than 20 October2012 for the next 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 the FIGO Secretariat © FIGO2012.

International Federation of Gynecology and Obstetrics

Dr Lalonde receiving his medal from the Minister

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FIGO IN THE FIELD…

In ternat iona l Federat ion of Gynecology and Obstet r ics | August 20128

Latest from the LOGIC InitiativeSaving the lives ofmothers throughfacility-basedMaternal Deathand Near MissReviews inEthiopia

The Ethiopian Society ofObstetricians and Gynecologists

(ESOG) has – through the support of the FIGOLOGIC Initiative (Leadership in Obstetrics &Gynaecology for Impact and Change) in Maternaland Newborn Health (MNH) – been working withthe Ethiopian Government and other partners tointroduce facility-based Maternal Death Reviews(MDRs) and Near Miss Reviews (NMRs) in eightpublic hospitals in Ethiopia. This has been doneas part of national efforts in Ethiopia to achieveMillennium Development Goal 5 to improvereproductive and maternal health. The maternalmortality in Ethiopia is 676 per 100,000 live births(Ethiopian Demographic Health Survey 2011).

It is possible to prevent most maternal deathsand disabilities with known and effectiveinterventions, but this requires the right kind ofinformation on why women are dying or facinglifelong disabilities. It is not enough to haveinformation on the overall levels of maternalmortality and morbidity – health policy makersand practitioners need to understand theunderlying factors to be able to prevent futuredeaths and disabilities.

A facility-based MDR is a ‘qualitative, in-depthinvestigation of the causes of and circumstancessurrounding maternal deaths’ in health facilities,while a NMR is the ‘identification and assessmentof cases in which pregnant women surviveobstetric complications’ (Lewis, 20031 p. 33). Thelessons learned from MDRs/NMRs lead torecommendations for improvements in care toprevent future deaths and disabilities. It is not aprocess for handing out blame or shame, butexists to identify and learn lessons to help ensurethat mothers are healthy in the future.

ESOG has implemented facility-based MDRs andNMRs at eight public hospitals in four regions ofEthiopia (Addis Ababa, Amhara, Oromia andSNNPR) since 2011. It has successfully beenworking with the public health facilities to ensurestaff ownership of the process. The fact thathospital staff have not been reluctant to reportmaternal deaths or near misses, nor have theyfeared punitive action, is a credit to thesuccessful management of the implementation ofMDRs/NMRs by ESOG. The data has beencollected by multi-disciplinary hospitalcommittees by using structured and standardMDR/NMR tools. The near-miss definition wasbased on validated disease-specific criteria.

ESOG has conducted primary analysis offacility-based MDR/NMR data between May andOctober 2011 from eight hospitals to find out thecauses and circumstances surrounding maternalmortality and morbidity. During this period therewere 119 maternal deaths and 989 near misscases out of a total of 9,712 women giving birth.This represents a maternal mortality rate of1318/100,000 live births. 1.2 per cent of the totalfacility-based deliveries result in maternal deaths.The ratio of maternal death to near miss is nearly1:9.

The leading causes of maternal deaths and nearmisses were: preeclampsia/eclampsia (29 percent); obstetric haemorrhage (16 per cent); anduterine rupture (13 per cent). Nearly 52.8 per centof deliveries were attended at home and phase Idelay (delay in decision to seek care) contributedto about 25 per cent of maternal deaths and nearmisses in the health facilities.

ESOG has also found that the MDRs/NMRsprovide a good learning experience for staff if thereviews are done in a participatory manner, usinga team approach. The MDRs/NMRs haveresulted in change in clinical practice within thehealth facilities. For example, as a result of theMDR/NMR process, the hospital at Debre Berhanhas reported many improvements, includingincreased use of the partogram from 48 per centto 85 per cent; increased and appropriate

FIGO LOGIC support for MDRs and NMRsFIGO LOGIC, funded by the Bill & Melinda Gates Foundation, is working with eight FIGOMember Associations (MAs), internationally renowned Maternal Death Review (MDR) experts,and other partners to influence and improve the use of maternal death notification systemsand/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) areworking closely with Ministries of Health, relevant health authorities, hospital management inselected 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 theWorld Health Organization publication: ‘Beyond the Numbers – Reviewing maternal deaths andcomplications to make pregnancy safer’ (2004).

FIGO LOGIC is working towards contributing to nationally, sustainable MDR/NMR processes overthe longer-term with the aim of helping to improve maternal health services and preventing futurematernal deaths and disabilities.

Gynecologists and obstetricians, together with other health care professionals, have an importantrole to play in improving MNH policy and clinical practice, including through the implementation offindings and recommendations coming out of MDR and NMR processes.

The following FIGO MAs are participating in the FIGO LOGIC Initiative in Maternal andNewborn Health: Société des Gynécologues et Obstétriciens du Burkina Faso (SOGOB);Society of Gynaecologists and Obstetricians of Cameroon (SOGOC); Ethiopian Society ofObstetricians and Gynecologists (ESOG); The Federation of Obstetric and GynaecologicalSocieties of India (FOGSI); Associação Moçambicana de Obstetras e Ginecologistas(AMOG); Nepal Society of Obstetricians and Gynaecologists (NESOG); Society ofGynaecology and Obstetrics of Nigeria (SOGON); Association of Obstetricians andGynaecologists of Uganda (AOGU).

administration of magnesium sulphate; andbetter adherence to protocols and increasedavailability of drugs. The hospital is also workingtowards acquiring ambulance transport andsetting up a ‘mini’ blood bank.

The successful implementation of MDRs/NMRsrequires strong partnership between theGovernment, including the Federal Ministry ofHealth (FMoH) and regional health authorities,and other partners, including UN agencies andmajor bilateral donors. ESOG has throughout thisprocess been working very closely with theEthiopian Government as well as other partners.

Incorporating facility-based MDRs/NMRs into theroutine national maternal health programme iskey in finding out the causes and circumstancessurrounding maternal deaths and near misses, sothat improvements in care can be implemented -thereby preventing future deaths and disabilities.The FMoH is currently working to standardise theESOG-initiated MDR/NMR tools and practicewith the aim to incorporate this into the routinenational programmes.

This article was prepared with the assistance ofDr Yirgu Gebrehiwot, ESOG President, BirukkidusTekleselassie, Project Manager, FIGO-LOGICInitiative in MNH, and Selamawit Kifle, ESOGGeneral Manager.1 Lewis, Gwyneth, 2003. ‘Beyond the Numbers: reviewing maternaldeaths and complications to make pregnancy safer”, British MedicalBulletin 2003; 67: 27–37, The British Council, 2003.

MDR Workshop, Addis Ababa, 23 June 2012: L–R (left handtable): Dr Segun Adeoye, Dr Fred Achem, Dr ChrisAgboghoroma; L–R (right-hand table): includes ProfessorRobert Leke, Dr Philip Nana, Dr Jolly Beyeza and Dr DanielMurokora

David Taylor, FIGO LOGIC Project Director

Dr Yirgu Gebrehiwot, ESOG President

Birukkidus Tekleselassie, Project Manager (ESOG),FIGO-LOGIC Initiative in MNH

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Misoprostol and PPH:high profile at Rome 2012

In ternat iona l Federat ion of Gynecology and Obstet r ics | August 2012 9

PANEL 1 – Misoprostol for the Preventionand Treatment of Post-PartumHaemorrhage: The Clinical Evidence &International Recommendations

Session Moderator: Zarko Alfirevic(University of Liverpool)

Name of Presenter and Title of Presentation1. Sir Sabaratnam Arulkumaran (FIGO) – TheGlobal Challenge of PPH and New FIGOGuidelines on the Prevention andTreatment of PPH with Misoprostol

2. Metin A Gülmezoglu (WHO) – The WorldHealth Organization Recommendations onPPH

3. Wilfrido León (Hospital Gineco-ObstétricoIsidro Ayora) – Sublingual Misoprostol forTreatment of PPH: Dose and Side Effects

4. Rasha Dabash (Gynuity Health Projects) –Programmatic Implications of CurrentStrategies and New Approaches toIntegrating Misoprostol for PPHManagement

5. Beverly Winikoff (Gynuity Health Projects)– Why Misoprostol Matters

Misoprostol: What doesFIGO recommend?PPH Prevention: FIGOrecommends a single dose of600mcg misoprostol administeredorally immediately after delivery ofthe newborn and after it isestablished that there are noadditional babies in utero.PPH Treatment: FIGOrecommends a single dose of800mcg misoprostol, administeredsublingually immediately after PPHis diagnosed and if 40 IU IVoxytocin is not immediately available(irrespective of the prophylacticmeasures).Extracts from FIGO Guidelines that focus on theprevention and treatment of post-partumhaemorrhage with misoprostol, scheduled forpublication in 2012

– an update on theMisoprostol for Post-Partum Haemorrhage(PPH) in Low ResourceSettings InitiativeIn October 2012 Rome will provide the settingfor FIGO’s XX World Congress of Gynecologyand Obstetrics, an important triennial eventattracting leading experts in women’s healthand rights from around the world. The ScientificProgramme includes two FIGO-sponsoredexpert panel sessions, scheduled for themorning of Wednesday 10 October 2012, thatwill focus on the prevention and treatment ofPPH with misoprostol.

PANEL 2 – Misoprostol for the Preventionand Treatment of Post-PartumHaemorrhage: Innovative CountryApproaches in Low-Resource Settings

Session Moderator: Jeffrey Smith (Jhpiego)

Name of Presenter and Title of Presentation1. Jennifer Blum (Gynuity Health Projects) –Misoprostol: A Proven Technology forPrevention and Treatment of PPH –Overview of the Clinical Evidence

2. Swaraj Rajbhandari (Senior Public HealthSpecialist) – Scale-up of Misoprostol forPPH Prevention at the Country Level:Nepal

3. Andrew Weeks (University of Liverpool) –Community-Based Use of Misoprostol forPPH Prevention: Snapshot from a PilotStudy in Uganda Documenting Self-Administration of Misoprostol in a HomeDelivery Setting

4. Susan Mukasa (Population ServicesInternational / PACE-Uganda) –Community-Based Distribution Models forRolling Out Misoprostol for PPHPrevention: Experience and LessonsLearned from Uganda and Tanzania

5. Shafiq Mirzazada (Aga Khan HealthServices, Afghanistan) – Misoprostol forthe Treatment of PPH Following its Use forPrevention (Afghanistan & Pakistan)

FIGO symposium success at RCOG CongressA FIGO Symposiumattracted over 300delegates who hadgathered in Sarawak,Malaysia, in June2012, to take partin the 10th RoyalCollege ofObstetricians andGynaecologists’(RCOG)InternationalScientific Congress.FIGO’s ChiefExecutive, ProfessorHamid Rushwan,moderated the

Symposium, which focused on the evidence around the prevention and treatment ofpost-partum haemorrhage with misoprostol.

Dr Nadeem Zuberi (Aga Khan University, Pakistan) opened by reviewing studies on the efficacy andsafety of 600mcg oral misoprostol to prevent PPH in community-based settings, including whenadministered by trained traditional birth attendants during home deliveries in Pakistan (Mobeen etal. 2010). Professor Emad Darwish (University of Alexandria, Egypt) followed by discussing twolarge multi-site studies that review the efficacy of misoprostol 800mcg sublingual compared to 40IU IV oxytocin for treatment of PPH in hospitals where oxytocin prophylaxis is provided during thethird stage of labour and in others where it is not provided (Winikoff et al. 2010; Blum et al. 2010).

Dr Alka Barua (Public Health Consultant, India) continued by presenting an analysis of a pilot studythat sought to understand better the relationship between misoprostol dose and occurrence ofelevated body temperature (≥40°C), using a lower dose of sublingual misoprostol for the treatmentof PPH, among one population in Ecuador where an unexpectedly high rate of fever had previouslybeen recorded (Durocher et al. 2010). Holly Anger (Gynuity Health Projects, USA) looked atalternative strategies for managing PPH, focusing her presentation on a ‘secondary prevention’study currently underway that bridges PPH prevention and treatment strategies, whereby a safeand effective treatment dose of misoprostol (800 mcg sublingual) is selectively administered towomen, such as those who bleed 350 mL (less than accepted definitions of PPH). ‘Secondaryprevention’ would medicate fewer women, could improve acceptability, may be more cost-effectivecompared to universal prophylaxis, and may alleviate fears of delayed time to transfer associatedwith a treatment-only approach.

The Symposium was rounded off by a presentation from Swaraj Rajbhandari (Senior PublicHealth Specialist, Nepal) who discussed a government-approved expansion programme ofcommunity-based distribution of misoprostol for PPH prevention across 28 districts of Nepal,and reviewed the findings from a pilot study, conducted in the Banke district, which establishedthat misoprostol distribution, given to pregnant women to self-administer at the time of theirdelivery as a prophylaxis, can be successfully implemented under government health services ina low-resource and geographically challenging setting (Rajbhandari et al. 2010).

L–R: Holly Anger (USA); Clare Waite (UK); Professor Hamid Rushwan (UK); ProfessorEmad Darwish (Egypt); Dr Alka Barua (India); Swaraj Rajbhandari (Nepal); and Dr NadeemZuberi (Pakistan)

United Nations High-LevelCommission on Life-SavingCommodities for Womenand ChildrenA report, UN Commission on Life SavingCommodities for Women and Children: CountryCase Studies, developed by the MaternalHealth Task Force was made public in May2012.

It focuses on three maternal health commodities– oxytocin, misoprostol and magnesium sulphate– in six countries that carry a high burden ofmaternal mortality: Bangladesh, India, Ethiopia,Nigeria, Tanzania, and Uganda.

It highlights barriers to access as well asinnovations and best practices for expanding theavailability of the three agents in low resourcecountries, and was completed on behalf of theUN Commission on Life-Saving Commodities,launched in March 2012 to increase access to 13life-saving medicines and health supplies for theworld’s most vulnerable people.

The Commission will issue its recommendationsat the UN General Assembly in September 2012.

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In ternat iona l Federat ion of Gynecology and Obstet r ics | August 201210

FIGO joins the Reproductive Health Supplies Coalition

www.figo2012.orgAfter three years of intensive preparations,FIGO’s World Congress finally opens forbusiness on 7 October 2012!

Professor Hamid Rushwan, FIGO’s ChiefExecutive, commented: ‘Visitors will be treated toa superlative Scientific Programme, ablyoverseen by Professor William Dunlop, Chair ofthe FIGO 2012 Scientific ProgrammeCommittee.’

He added: ‘The programme explores currentdevelopments in the areas of Maternal and FetalMedicine, Reproductive Medicine, GynecologicalOncology, Urogynecology and Sexual andReproductive Health, as well as the very criticalpractical implications of providing healthcare towomen in high- and low-resource settings. TheProgramme Committee comprisesrepresentatives of international subspecialty

Register before 31 August 2012 to take advantage of ‘regular registration’!Tipology Registration fee Euro Category

Congress To 31 Aug 2012 850 regular registrationCongress From 01 Sept 2012 to 15 Sept 2012 950 late registrationCongress From 06 Oct 2012 onward 950 on site registrationPre-Congress courses Course 1: Basic course on ultrasound 100 regular registrationPre-Congress courses Course 2: Diabetes and pregnancy in low-resource countries 100 regular registrationPre-Congress courses Course 3: Postpartum haemorrhage 100 regular registrationPre-Congress courses Course 4: Basic course on endoscopy 100 regular registrationPre-Congress courses Course 5: Basic course on colposcopy 100 regular registrationPre-Congress courses Course 6: The FIGO Fertility Tool Box™ 100 regular registrationPre-Congress courses Course 7: The Global Obstetrics Network (GONet) 100 regular registration

organisations and also the Chairs of FIGO’sCommittees and Working Groups to ensure up-to-the minute information on current globaldevelopments.

‘Over 1700 abstracts have been accepted fororal or poster presentation – as a result of thistremendous global interest, the Congress is ontrack to provide a major opportunity for theexchange of ideas between all cadres ofhealthcare professionals and other stakeholdersacross the world.’

Programme highlights include• LIVE SURGERY SESSIONS – transmitted fromEuropean hospitals

• NEW CLINICAL GUIDELINES – presented byrepresentatives of FIGO, WHO and other globalNGOs

• SPECIAL SESSIONS ON INDIVIDUALCOUNTRIES’ EXPERIENCES – presented bynational and international ob/gyn societies

FIGO is delighted to announce that it hasrecently become a member of theReproductive Health Supplies Coalition, ‘aglobal partnership of public, private, andnon-governmental organisations dedicated toensuring that all people in low- and middle-income countries can access and useaffordable, high-quality supplies to ensuretheir better reproductive health’.

FIGO puts finishing touchesto World Congress 2012!

The Coalition brings together multilateral andbilateral organisations, private foundations,governments, civil society, and private-sectorrepresentatives that play critical roles in providingcontraceptives and other reproductive healthsupplies.

John P Skibiak, Director, Coalition Secretariat,commented: ‘It’s an honour and privilege towelcome FIGO on board the Coalition’s

A Scientific Programmeis now online: visit http://www.figo2012.org/scientific-programme/ for a full overview.

FIGO eases travel to RomeCongressFIGO has made plans to ease the travel ofparticipants from the city to the Congress venue(Fiera di Roma) and back. On registration,participants will receive a free travel card for use onpublic transport to be utilised throughout theCongress, which will be included in their delegatepacks. Please access this link for full details of howto travel to the venue: http://www.figo2012.org/public-transportation/ (a Rome metro and cityrailways map).

Opening and ClosingCeremoniesSunday 7 October 2012The official inauguration of the XX FIGO WorldCongress will take place at Fiera di Roma onSunday 7 October 2012 (6.00–7.30pm). Areception will be held in the same location afterthe Ceremony.

Friday, 12 October 2012The Closing Ceremony will take place at Fiera diRoma on Friday 12 October 2012(12.30–1.30pm). The Ceremony will mark theclose of the Congress and inauguration of theincoming FIGO President Professor SirSabaratnam Arulkumaran.

Vancouver, Canada will be presented as the hostcity of the XXI FIGO Congress in 2015.

membership. FIGO isbuilt on the power ofpartnership, just asthe Coalition is; itswork for the wellbeingof women dovetailsperfectly with ourown commitmentto provide all womenwith a choice ofsafe, moderncontraception. I lookforward to a long and

productive relationship with our newest – and200th – member.’

For detailed information on theCoalition’s work, please visit:http://www.rhsupplies.org/about-us.html

John P Skibiak

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Are you missing out on key articles?

The Journal is the offi cial publication of the International Federation of

Gynecology and Obstetrics (FIGO).

Remember 2012 subscriptions are just $80 for members of FIGO national societies. See www.ijgo.org/pricing to subscribe online

International Journal of

Gynecology& Obstetrics2012 subscriptions are just $80 for members of FIGO national societies!

See www.ijgo.org/pricing for more information and to subscribe online

This journal publishes articles on all aspects of basic and clinical research in the fi elds of obstetrics and gynecology and related subjects, with special emphasis on matters of worldwide interest.

It features:

Editorials Articles Case Reports BriefCommunications International Calendar SOGC Clinical Practice Guidelines ReviewArticles and sections on, Contemporary Issues in Women’s Health; Averting Maternal Death and Disability; and Surgery and Technology.

International Journal of Gynecology & Obstetrics also:

submission at http://ees.elsevier.com/ijg

www.ijgo.org

10660:Layout 1 10/8/12 12:44 Page 11

www.figo2012.org

7th - 12th October 2012

fiera di Roma

Rome, Italy

Organised by

INTERNATIONAL FEDERATION OFGYNECOLOGY & OBSTETRICS

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