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I362 THE FIGO LEADERSHIP IN OBSTETRICS & GYNAECOLOGY FOR IMPACT AND CHANGE (LOGIC) INITIATIVE
Invited presentations and presentations by organisations and societies / International Journal of Gynecology & Obstetrics 119S3 (2012) S161–S260
S251
D.J. Taylor, B. Vander Plaetse, H. Lindborg. FIGO
I363 SUBMUCOSAL MYOMA: TECHNIQUE AND LIMITS – HYSTEROSCOPY A. Tinelli. Department of Gynecology and Obstetrics, Vito Fazzi Hospital, Lecce, Italy
FIGO, through the Leadership in Obstetrics & Gynaecology for Impact and Change (LOGIC) Initiative, is developing the capacity of national professional associations of Obstetrics and Gynaecology in countries with high maternal and neonatal death rates, so that they can influence policy and practise in maternal and newborn health more effectively. The Initiative is running in Africa (Burkina Faso, Cameroon, Ethiopia, Mozambique, Nigeria and Uganda) and Asia (India and Nepal). All the associations have led the development of maternal death/near miss reviews in their countries, as a means of improving care at facility level and proving information for policy change at federal/national level. Under the leadership of the associations and in collaboration with national and international partners, tools and guidelines for multidisciplinary reviews have been developed and tested in a small number of facilities, aiming for national roll-out to achieve impact at scale. Improvements in care are being witnessed at facility level, policy makers are being sensitised and scaling up to reach all facilities is planned in three countries. In common with other developments of this kind, the challenges of achieving a no name, no blame culture and ensuring actions occur from the lessons learned remain. However, scale up in a number of countries is close and should, with the appropriate support, lead in time to the development of confidential enquiries into maternal deaths. In common with the South African and UK confidential enquiries, national professional associations will have to play a pivotal role in order to achieve success. Acknowledgement: FIGO LOGIC is funded by the Bill & Melinda Gates Foundation.
The role of uterine fibroids or leiomyomata in female reproductive wellbeing has been the subject of debate for many years. Leiomyomas are associated with infertility and abortions, the causal relationship in this regard appearing to be more evident for submucosal myomas. Fertility outcomes demonstrated to be improved only with excision of submucous leiomyomas. Submucous fibroids may also induce severe clinical symptoms such as excessive bleeding, usually during menses, colicky dysmenorrhoea. Submucosal myomas should be treated by hysteroscopic resection. The choice of hysteroscopic techniques used to treat fibroids found completely within the uterine cavity (G0) and those with intramural development (G1 and G2), mostly depends on the intramural extension of the fibroid, as well as on personal experience and equipments. Resectoscopic slicing still represents the ‘gold standard’ technique for treating fibroids G0. Literature also proposed other techniques, including ablation by neodymium-yttrium-aluminum-garnet laser, morcellation and office myomectomy, but without long term outcomes. There is still no single technique proven to be unequivocally superior for treating fibroids G1 and G2. At present, the ‘cold loop’ technique seems to represent the best option as it allows a safe and complete removal of such fibroids in just one surgical procedure, while respecting the surrounding healthy myometrium. As limit of hysteroscopic myomectomy, fibroids G1 and G2 should not exceed 5–6 and 4–5 cm, respectively, to be removed hysteroscopically. While fibroids <1.5–2 cm, with a minimal intramural component, can be removed in outpatient setting using smaller diameter hysteroscopes and 5Fr mechanical and bipolar instruments.
I361 THE IMPLEMENTATION OF MATERNAL DEATH/NEAR-MISS REVIEWS BY FIGO NATIONAL PROFESSIONAL ASSOCIATIONS OF OBSTETRICS & GYNAECOLOGY IN AFRICA AND ASIA
I362 THE FIGO LEADERSHIP IN OBSTETRICS & GYNAECOLOGY FOR IMPACT AND CHANGE (LOGIC) INITIATIVE D.J. Taylor, B. Vander Plaetse, H. Lindborg. FIGO FIGO, though the Leadership in Obstetrics & Gynaecology for Impact and Change (LOGIC) Initiative, is developing the capacity of national professional associations of Obstetrics and Gynaecology in countries with high maternal and neonatal death rates, so that they can influence policy and practise in maternal and newborn health more effectively. The Initiative is running in Africa (Burkina Faso, Cameroon, Ethiopia, Mozambique, Nigeria and Uganda) and Asia (India and Nepal). The Initiative has a number of objectives including • Evidence-informed policy strategy and action plans on maternal and new born health influenced and supported through member associations advocating to raise and maintain awareness of, and investment in, maternal and new born health and engaging in dialogue with health sector stakeholders. (Policy Influence) • Progress is made in delivering evidence informed policy, strategic objectives and operational/annual plans with the member association’s active role in implementation, monitoring and evaluation. (Practise Improvement) • National and sub-national member association organisation strengthened to enable effective participation in national and sub-national strategic and operational for a related to maternal and new born health.(Capacity Building) Progress made by the professional associations in organisational capacity and the development of maternal death/near miss reviews, as a tool to improve clinical practise and improve maternal health, will be presented.
I364 RESEARCH TO PREVENT TOBACCO USE AND SECONDHAND SMOKE EXPOSURE IN PREGNANCY Y. Hunt, J. Tolosa Tobacco use and secondhand smoke (SHS) exposure are widely viewed as serious threats to the health of pregnant women, infants, and children. In many high-income countries, tobacco use has long been a leading preventable cause of poor pregnancy and infant outcomes. In many low- and middle-income countries, few pregnant women use tobacco, but this is changing because of tobacco industry marketing aimed at normalizing tobacco use by women, the erosion of traditional constraints on women’s tobacco use, and other factors. Increasing tobacco use and SHS exposure among pregnant women in low- and middle-income countries, where poor pregnancy outcomes are already common, threatens efforts to improve maternal and children health. Research to better understand women’s use of cigarettes and other tobacco products and SHS exposure during pregnancy and postpartum can inform the development of culturally appropriate and effective interventions for use by OB/GYNs, midwives, and other health professionals. This presentation will provide an overview of key findings and research needs identified by an expert working group convened by the Global Network for Perinatal and Reproductive Health, the U.S. Centers for Disease Control and Prevention, and the U.S. National Cancer Institute. The expert working group provided research recommendations in three areas: 1) Social and cultural factors influencing pregnant women’s use of tobacco and exposure to SHS; 2) Interventions to promote tobacco cessation and reduce SHS exposure during pregnancy in high-, low- and middleincome countries; and 3) Describing non-cigarette tobacco use by women and characterizing the resulting risks for adverse pregnancy outcomes.
S251
D.J. Taylor, B. Vander Plaetse, H. Lindborg. FIGO
I363 SUBMUCOSAL MYOMA: TECHNIQUE AND LIMITS – HYSTEROSCOPY A. Tinelli. Department of Gynecology and Obstetrics, Vito Fazzi Hospital, Lecce, Italy
FIGO, through the Leadership in Obstetrics & Gynaecology for Impact and Change (LOGIC) Initiative, is developing the capacity of national professional associations of Obstetrics and Gynaecology in countries with high maternal and neonatal death rates, so that they can influence policy and practise in maternal and newborn health more effectively. The Initiative is running in Africa (Burkina Faso, Cameroon, Ethiopia, Mozambique, Nigeria and Uganda) and Asia (India and Nepal). All the associations have led the development of maternal death/near miss reviews in their countries, as a means of improving care at facility level and proving information for policy change at federal/national level. Under the leadership of the associations and in collaboration with national and international partners, tools and guidelines for multidisciplinary reviews have been developed and tested in a small number of facilities, aiming for national roll-out to achieve impact at scale. Improvements in care are being witnessed at facility level, policy makers are being sensitised and scaling up to reach all facilities is planned in three countries. In common with other developments of this kind, the challenges of achieving a no name, no blame culture and ensuring actions occur from the lessons learned remain. However, scale up in a number of countries is close and should, with the appropriate support, lead in time to the development of confidential enquiries into maternal deaths. In common with the South African and UK confidential enquiries, national professional associations will have to play a pivotal role in order to achieve success. Acknowledgement: FIGO LOGIC is funded by the Bill & Melinda Gates Foundation.
The role of uterine fibroids or leiomyomata in female reproductive wellbeing has been the subject of debate for many years. Leiomyomas are associated with infertility and abortions, the causal relationship in this regard appearing to be more evident for submucosal myomas. Fertility outcomes demonstrated to be improved only with excision of submucous leiomyomas. Submucous fibroids may also induce severe clinical symptoms such as excessive bleeding, usually during menses, colicky dysmenorrhoea. Submucosal myomas should be treated by hysteroscopic resection. The choice of hysteroscopic techniques used to treat fibroids found completely within the uterine cavity (G0) and those with intramural development (G1 and G2), mostly depends on the intramural extension of the fibroid, as well as on personal experience and equipments. Resectoscopic slicing still represents the ‘gold standard’ technique for treating fibroids G0. Literature also proposed other techniques, including ablation by neodymium-yttrium-aluminum-garnet laser, morcellation and office myomectomy, but without long term outcomes. There is still no single technique proven to be unequivocally superior for treating fibroids G1 and G2. At present, the ‘cold loop’ technique seems to represent the best option as it allows a safe and complete removal of such fibroids in just one surgical procedure, while respecting the surrounding healthy myometrium. As limit of hysteroscopic myomectomy, fibroids G1 and G2 should not exceed 5–6 and 4–5 cm, respectively, to be removed hysteroscopically. While fibroids <1.5–2 cm, with a minimal intramural component, can be removed in outpatient setting using smaller diameter hysteroscopes and 5Fr mechanical and bipolar instruments.
I361 THE IMPLEMENTATION OF MATERNAL DEATH/NEAR-MISS REVIEWS BY FIGO NATIONAL PROFESSIONAL ASSOCIATIONS OF OBSTETRICS & GYNAECOLOGY IN AFRICA AND ASIA
I362 THE FIGO LEADERSHIP IN OBSTETRICS & GYNAECOLOGY FOR IMPACT AND CHANGE (LOGIC) INITIATIVE D.J. Taylor, B. Vander Plaetse, H. Lindborg. FIGO FIGO, though the Leadership in Obstetrics & Gynaecology for Impact and Change (LOGIC) Initiative, is developing the capacity of national professional associations of Obstetrics and Gynaecology in countries with high maternal and neonatal death rates, so that they can influence policy and practise in maternal and newborn health more effectively. The Initiative is running in Africa (Burkina Faso, Cameroon, Ethiopia, Mozambique, Nigeria and Uganda) and Asia (India and Nepal). The Initiative has a number of objectives including • Evidence-informed policy strategy and action plans on maternal and new born health influenced and supported through member associations advocating to raise and maintain awareness of, and investment in, maternal and new born health and engaging in dialogue with health sector stakeholders. (Policy Influence) • Progress is made in delivering evidence informed policy, strategic objectives and operational/annual plans with the member association’s active role in implementation, monitoring and evaluation. (Practise Improvement) • National and sub-national member association organisation strengthened to enable effective participation in national and sub-national strategic and operational for a related to maternal and new born health.(Capacity Building) Progress made by the professional associations in organisational capacity and the development of maternal death/near miss reviews, as a tool to improve clinical practise and improve maternal health, will be presented.
I364 RESEARCH TO PREVENT TOBACCO USE AND SECONDHAND SMOKE EXPOSURE IN PREGNANCY Y. Hunt, J. Tolosa Tobacco use and secondhand smoke (SHS) exposure are widely viewed as serious threats to the health of pregnant women, infants, and children. In many high-income countries, tobacco use has long been a leading preventable cause of poor pregnancy and infant outcomes. In many low- and middle-income countries, few pregnant women use tobacco, but this is changing because of tobacco industry marketing aimed at normalizing tobacco use by women, the erosion of traditional constraints on women’s tobacco use, and other factors. Increasing tobacco use and SHS exposure among pregnant women in low- and middle-income countries, where poor pregnancy outcomes are already common, threatens efforts to improve maternal and children health. Research to better understand women’s use of cigarettes and other tobacco products and SHS exposure during pregnancy and postpartum can inform the development of culturally appropriate and effective interventions for use by OB/GYNs, midwives, and other health professionals. This presentation will provide an overview of key findings and research needs identified by an expert working group convened by the Global Network for Perinatal and Reproductive Health, the U.S. Centers for Disease Control and Prevention, and the U.S. National Cancer Institute. The expert working group provided research recommendations in three areas: 1) Social and cultural factors influencing pregnant women’s use of tobacco and exposure to SHS; 2) Interventions to promote tobacco cessation and reduce SHS exposure during pregnancy in high-, low- and middleincome countries; and 3) Describing non-cigarette tobacco use by women and characterizing the resulting risks for adverse pregnancy outcomes.