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International Federation of
FIGO
FIGO Gynecology and Obstetrics
communications@figo.org
www.figo.org 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

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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 Women's 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

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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
http://www.figo2012.org/registration 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 www.figo.org
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

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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
(www.gynuity.org), 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 www.gynuity.org
Committees, project teams, and collaborating organisations.
Clare added: ‘A particular focus of the Editorial Board Meeting was the
development of the IJGO website – www.ijgo.org – 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 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 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

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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

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SAVING MOTHERS AND NEWBORNS INITIATIVE
Looking back; moving forward
(2006–2011, funded by the Swedish International Development Cooperation Agency – www.sida.se – 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 www.figo.org’
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 http://www.figo.org/projects/newborns
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. 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).
http://www.figo.org/publications/PPH_G
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:
http://www.who.int/pmnch/topics/part_publications/201112_
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 communications@figo.org 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: figo@figo.org
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. 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