FIGO Misoprostol for PPH in Low Resource Settings Initiative

Millennium Development Goal 5 (MDG 5)

Two targets:

 

Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

Achieve, by 2015, universal access to reproductive health

 

 

BACKGROUND

The number of women dying as a result of complications related to pregnancy and childbirth remains unacceptably high. This is especially true in low resource countries across sub-Saharan Africa and South Asia where almost all these deaths occur and where a high percentage of women deliver at home or outside a health facility without immediate recourse to emergency obstetric care or a skilled birth attendant. 

Post-partum haemorrhage (PPH) is the most significant direct cause of maternal mortality in low resource countries, accounting for approximately 30 per cent of maternal deaths worldwide, and is one of the most preventable. The most common cause of PPH is uterine atony, a failure of the uterus to contract adequately after delivery of the newborn(s). A key aspect in PPH prevention and treatment is uterotonic therapy and the most widely recommended agent is oxytocin. Certain factors can hinder its use in low resource settings. Oxytocin requires parenteral administration, and, therefore, skills to give injections as well as sterile equipment, and refrigeration. 

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

 

ABOUT THE FIGO INITIATIVE (2010-2014)

The FIGO 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 that is looking at ways to translate scientific and operational research on misoprostol for PPH into effective policies, programmes and practice. 

In collaboration with FIGO’s Committee for Safe Motherhood and Newborn Health, professional associations and others, FIGO’s activities include: 

  • Conducting expert panel sessions at global obstetric and gynaecologic meetings to present current evidence & to discuss programmatic implications
  • Publishing scientific articles, editorials & communications in FIGO’s official journal, the International Journal of Gynecology and Obstetrics (IJGO)
  • Producing an IJGO supplement on Misoprostol for PPH
  • Conducting expert panel sessions at the FIGO World Congress in Rome
  • Developing guidelines, protocols and other training materials
  • Conducting national workshops

 

PROJECT TEAM

Project Director - (FIGO Chief Executive) Hamid Rushwan

Project Manager - Upeka de Silva

 

FIGO GUIDELINES ON THE PREVENTION AND TREATMENT OF PPH WITH MISOPROSTOL These Guidelines, published by FIGO in 2012, reflect the latest best available research on the use of misoprostol for PPH prevention and treatment. The guidelines include evidence-based recommendations for dosages and routes of administration, as well as the side effects and precautions associated with its use.

The Guidelines were developed after a review of the published literature by an expert panel that met in New York in 2011, and were subsequently endorsed by FIGO’s Executive Board members at their annual meeting in May 2012. They are available in French and Spanish translation.

PPH Prevention 

FIGO recommends a single dose of 600mcg misoprostol administered orally immediately after delivery of the newborn and after it is established that there are no additional babies in utero 

Abbreviated Versions

English: Prevention of Post-Partum Haemorrhage with Misoprostol

Français: Le Misoprostol dans la Prévention de l’Hémorragie du Postpartum

Español: Prevención de la Hemorragia Postparto con Misoprostol 

Annotated Versions

English: Prevention of Post-Partum Haemorrhage with Misoprostol

Français: Le Misoprostol dans la Prévention de l’Hémorragie du Postpartum

Español: Prevención de la Hemorragia Postparto con Misoprostol 

Portuguese: Prevenção de Hemorragia Pós-Parto com Misoprostol

PPH Treatment 

FIGO recommends a single dose of 800 mcg misoprostol, administered sublingually immediately after PPH is diagnosed and if 40 IU IV oxytocin is not immediately available (irrespective of the prophylactic measures). 

Abbreviated Versions

English: Treatment of Post-Partum Haemorrhage with Misoprostol

Français: Le Misoprostol dans la Traitement de l’Hémorragie du Postpartum

Español: Tratamiento de la Hemorragia Postparto con Misoprostol 

Annotated Versions

English: Treatment of Post-Partum Haemorrhage with Misoprostol

Français: Le Misoprostol dans la Traitement de l’Hémorragie du Postpartum

Español: Tratamiento de la Hemorragia Postparto con Misoprostol 

Portuguese: Tratamento de Hemorragia Pós-Parto com Misoprostol

Related link FIGO’s Guidelines on the Prevention and treatment of postpartum hemorrhage in low-resource settings offer a comprehensive overview of a combination of best practice approaches and life-saving interventions along a continuum of care from community to hospital.  Published in the International Journal of Gynecology and Obstetrics [Volume 117, Issue 2, May 2012, Pages 108–118]. The Guidelines are available in French and Spanish translation.

 

RESOURCES  

Misoprostol Recommendations 2012 (French version, Spanish version, Portuguese version)

A special communication by Olufemi T. Oladapo – Misoprostol for preventing and treating postpartum hemorrhage in the community: A closer look at the evidence – published in the IJGO (2012) 

A policy brief – Scaling up misoprostol for postpartum haemorrhage: Moving from evidence to action – published by Family Care International (endorsed by FIGO, Gynuity Health Projects & PATH) (French version)

A special communication by Rasha Dabash et al. – Misoprostol for the management of postpartum bleeding: A new approach – published in the IJGO (2012)

An article by Sheila Raghavan et al. – Misoprostol for prevention and treatment of postpartum hemorrhage: What do we know? What is next? – published in the IJGO (2012)

A brief statement by FIGO's Safe Motherhood and Newborn Health Committee (31 August 2012) - FIGO reaffirms the use of misoprostol for the prevention and treatment of post-partum haemorrhage.

A special communication by Ann Starrs et al. – Misoprostol for postpartum hemorrhage: Moving from evidence to practice – published in the IJGO (2012)

A special editorial by Professor Hamid Rushwan - Misoprostol: An essential  medicine for managing postpartum hemorrhage in low-resource settings? - was published in the September 2011 issue of the IJGO.

 

 

 

WHO MODEL LIST OF ESSENTIAL MEDICINES 

18th Expert Committee on the Selection and Use of Essential Medicines  

The 18th Expert Committee on the Selection and Use of Essential Medicines took an important step when it approved the addition of misoprostol for the prevention of PPH to the WHO Model List of Essential Medicines.

For further information: The Selection and Use of Essential Medicines - Report of the WHO Expert Committee, 2011 

19th Expert Committee on the Selection and Use of Essential Medicines

In April 2013, the 19th Expert Committee on the Selection and Use of Essential Medicines will meet in Geneva to review and to update the WHO Model List of Essential Medicines.

An application for the inclusion of misoprostol (800 mcg sublingual) on the List for the treatment of post-partum haemorrhage (PPH) was submitted by Gynuity Health Projects and will be considered by the Expert Committee during the meeting.  

FIGO supports this effort to include misoprostol on the EML for its PPH treatment indication.  

 

World Congress 2015

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