Transcript Lale Say, WHO and Dina Abbas, Gynuity: Provisional New

31 May 2013
New Sexual and Reproductive
Health Guidelines and
Technologies
Sharon Phillips, Lisa Thomas, Lale Say
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Mission of HRP
To help people lead healthy
sexual and reproductive lives
Vision statement
The attainment by all peoples
of the highest possible level of
sexual and reproductive health
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Department of Reproductive Health and Research (RHR), including
UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research,
Development and Research Training in Human Reproduction (HRP)
Marleen Temmerman, Director
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Global strategies, frameworks and initiatives (ICPD, MDGs, H4+)
Partnerships and global advocacy
Oversight and coordination of research, research capacity building, work with
WHO Regional and Country offices and WHO collaborating centres
Biostatistics and data management
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Programme Management, HRP Trust Fund, HRP direct administrative support
Human Reproduction Team
Mario Merialdi, Coordinator
• Contraception / Family planning
• Reproductive tract and sexually
transmitted infections
• Infertility
• Women’s health
Maternal and Perinatal Health and
Preventing Unsafe Abortion Team
Adolescents and at-Risk Populations Team
Lale Say, Coordinator
Metin Gülmezoglu, Coordinator
• Maternal and perinatal health
• Prevention of unsafe abortion
• Pre-conception / pre-pregnancy
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Adolescent sexual and reproductive health
Gender-based and sexual violence
Harmful practices
Sexual and reproductive health in
emergencies, conflict, and humanitarian
crises, and of other at-risk populations
RHR/HRP’s mandate includes : (i) research; (ii) development of new technologies and interventions; (iii) systematic reviews and
evidence synthesis; (iv) setting norms, standards and guidelines; (vi) synthesis of global indicators and (vii) national research
capacity strengthening.
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WHO recommendations for the prevention and
treatment of post-partum haemorrhage (PPH)
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Since last IAWG
New recommendations on use
of oxytocin, misoprostol, cord
traction, cord clamping and the
non-pneumatic anti-shock
garment
Available online and on CD
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PPH Prevention
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Cord traction now optional (based on new evidence)
Prophylactic uterotonics recommended for all
women
– Oxytocin where available
– Other injectable uterotonics or misoprostol where
oxytocin not available
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PPH Treatment
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Uterotonics (first choice oxytocin)
Intrauterine balloon tamponnade for persistent
bleeding or if uterotonics unavailable
Non-pneumatic anti-shock garment recommended
as a temporizing measure while awaiting further care
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WHO Recommendations for prevention and
treatment of pre-eclampsia and eclampsia
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Released 2011
New recommendations on
use of magnesium sulfate
and antihypertensive drugs
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Prevention and treatment of preeclampsia/eclampsia
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Magnesium sulfate is the drug of choice for
treatment of eclampsia and prevention of eclampsia
in women with severe pre-eclampsia
In settings where the full dosage of magnesium
sulfate cannot be administered, a loading dose
followed by immediate transfer to an appropriate
facility is recommended
Women with severe hypertension in pregnancy
should also be treated with antihypertensive drugs
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Safe abortion: Technical and policy
guidance for health systems
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Released 2012
New recommendations
on medical abortion and
management of
incomplete abortion
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Safe abortion care
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Medical abortion regimens up to 24 weeks (either
mifepristone + misoprostol or misoprostol alone)
Treatment of incomplete abortion with vacuum
aspiration or misoprostol
Abortion can be safely provided by non-physician
clinicians when appropriately trained and supported
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Innovations for Humanitarian Settings:
Sexual and Reproductive Health Technologies
Co-hosted by Gynuity Health Projects, The
IFRC and WHO Department of Reproductive
Health and Research
 Purpose: Share recent updates in WHO
guidance and discuss evidence-based
reproductive health technologies
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Oxytocics
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The use of uterotonics for the prevention of PPH during the
third stage of labour is recommended for all births.
Oxytocin (10 IU, IV/IM) is the recommended uterotonic drug
for the prevention of PPH.
In settings where oxytocin is unavailable, the use of other
injectable uterotonics (if appropriate
ergometrine/methylergometrine or the fixed drug
combination of oxytocin and ergo- metrine) or oral
misoprostol (600 μg) is recommended.
In settings where skilled birth attendants are not present and
oxytocin is unavailable, the administration of misoprostol (600
μg PO) by community health care workers and lay health
workers is recommended for the prevention of PPH.
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Controlled cord traction
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In settings where skilled birth attendants are
available, CCT is recommended for vaginal births if
the care provider and the parturient woman regard a
small reduction in blood loss and a small reduction in
the duration of the third stage of labour as important
In settings where skilled birth attendants are
unavailable, CCT is not recommended.
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Cord clamping
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Late cord clamping (performed after 1 to 3 minutes
after birth) is recommended for all births while
initiating simultaneous essential newborn care.
(Strong recommendation, moderate- quality
evidence)
Early cord clamping (<1 minute after birth) is not
recommended unless the neonate is as- phyxiated
and needs to be moved immediately for
resuscitation. (Strong recommendation, moderatequality evidence)
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Uterine care
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Sustained uterine massage is not recommended as
an intervention to prevent PPH in women who have
received prophylactic oxytocin.
Postpartum abdominal uterine tonus assessment for
early identification of uterine atony is recommended
for all women. Oxytocin (IV or IM) is the
recommended uterotonic drug for the prevention of
PPH in c/section.
Controlled cord traction is the recommended
method for removal of the placenta in caesarean
section…
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