International Federation of Gynecology and Obstetrics

Rome, October 10th, 2012 – “Preventable deaths occur in considerable numbers during pregnancy and childbirth in the developing world where maternal mortality ranges from 200 to 2,000 per 100,000 live births. Moreover, for each woman who dies, an estimated 16 to 30 survive avoidable complications, often miserably,” said Professor Gamal Serour, President of the International Federation of Gynecology and Obstetrics (FIGO), presenting the most recent FIGO Initiatives for the prevention and treatment of post-partum haemorrhage and obstetric fistula in low-resource countries at the FIGO2012 World Congress in Rome, Italy (7-12 October 2012).

Post-partum haemorrhage (PPH) is the first cause of maternal mortality in low-resource countries, accounting for approximately 30% of maternal deaths, and is one of the most preventable. For PPH prevention and treatment uterotonic therapy is key and the most widely recommended agent is oxytocin. But oxytocin requires parenteral administration, as well as sterile equipment, and refrigeration, all factors hindering its use in low-resource settings. 

When injectable uterotonics are neither available nor feasible, misoprostol, a synthetic E1 prostaglandin analogue, has increasingly been adopted as an alternative strategy for PPH care – one endorsed by FIGO and other international bodies. Misoprostol is available in tablet form, stable at room temperature, well absorbed orally and sublingually, and requires few skills to administer.

“Our PPH Initiative, funded by a grant to Gynuity Health Projects from the Bill & Melinda Gates Foundation, advocates for and disseminates evidence-based information on misoprostol for PPH, aimed at healthcare providers and clinical policymakers. It is part of a global project for translating scientific and operational research into effective policies, programmes and practice,” Professor Hamid Rushwan, FIGO Chief Executive, explained.

“Another major concern for women who give birth in low-resource countries is obstetric fistula, perhaps the most tragic of preventable childbirth complications, as affected women in nearly all cases lose their babies, suffer from health problems, including chronic incontinence, and are often abandoned by their husbands, forced to live in shame and social segregation,” he continued.

Obstetric fistula is a hole in the birth canal usually caused by prolonged obstructed labour. It is preventable and largely avoidable by delaying the age of first pregnancy, stopping harmful traditional practices, and granting timely access to obstetric care. According to the World Health Organization, each year between 50,000 to 100,000 women develop obstetric fistula. More than 2,000,000 women live with untreated obstetric fistula in sub-Saharan Africa and Asia, where too few physicians are equipped with the skills needed to repair fistulae and care for patients following surgery.

FIGO, in collaboration with a number of stakeholders, recently launched its Fistula Initiative which focuses on the prevention and treatment of obstetric fistula in 12 African and Asian countries. “The aim of the Initiative is to ensure high quality clinical training for the care of women with obstetric fistula and to increase capacity of services and staff to provide comprehensive management and treatment of fistula through a programme of training of trainers and support to the training centres,” Professor Rushwan added.

For this purpose, FIGO co-ordinated the production of a dedicated manual, the Global Competency-Based Fistula Surgery Training Manual, to enable physicians to acquire the skills needed to prevent it and provide proper surgical, medical and psychosocial care to women who have incurred fistulae.

The manual was produced with funding from the United Nations Population Fund (UNFPA), and with the collaboration of fistula surgeons and professional and specialist health organisations. It was pilot tested in several centres and is now being utilised for training in accredited centres.

FIGO is also involved in the provision of training workshops on PPH, Minimally Invasive Surgery (MIS), obstetric ultrasonography, basic surgical skills and pelvic floor dysfunction surgery - these are conducted in many African and Asian countries as the issues are highly relevant to maternal mortality and morbidity.

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Diego Freri
FIGO2012 Press Office
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Maria D'Acquino
HealthCom Consulting Srl
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