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I92 Available pharmacologic treatment of the overactive bladder
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Invited presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S1–S92
few reports of improved perinatal outcome after the introduction of these programmes: in one large series there was a 100% increase in BPI and HIE after training was started in 2000. A recent editorial noted that “Practice does not make perfect, it the practice is wrong”. Simulation based studies have identified common difficulties in the management of SD and when these were incorporated into a training programme there was a 70% reduction in BPI and neonatal fractures. I will review the differences between these discrepant results and the data available from simulation-based studies to identify the ‘active ingredients of effective training’ for Shoulder Dystocia. I92 Available pharmacologic treatment of the overactive bladder H.P. Drutz. Toronto, Canada This presentation will review the current pharmacologic agents available to treat Overactive Bladder (OAB). The incidence, prevalence and differential diagnosis of this condition will be reviewed. The differences in mechanism of action, cardiovascular and cognitive side efeect profiles will be discussed. I93 Understanding postpartum hemorrhage: Its frequency and treatment G. Barrera, J. Blum, M. Cherine, R. Dabash, E. Darwish, B. Dao, B. Dilbaz, A. Diop, J. Durocher1 , I. Dzuba, HT. Kim Chi, W. Leon, I. Medhat, N.T.N. Ngoc, S. Raghavan, B. Winikoff, S. Yalvac. 1 Gynuity Health Projects, New York, USA Background: Recent surveys have shown wide variation in the practice of active management of the third stage of labor (AMTSL) – prophylactic uterotonic administration, controlled cord traction, and uterine massage – and to date, the individual impact of each component on postpartum bleeding has not be adequately examined. Design/Methods: From August 2005–January 2008, two clinical trials were completed in nine hospitals in Burkina Faso, Ecuador, Egypt, Turkey and Vietnam on PPH management. As part of this research, blood loss was measured for over 40,000 vaginal deliveries with calibrated drape for 1-hour postpartum. Sociodemographic characteristics, delivery practices, and pre- and postdelivery hemoglobin levels were documented for each participant. A post hoc analysis was conducted to determine the impact of AMTSL and its components on blood loss and the likelihood to have a PPH. Results/Outcomes: The rate of PPH was consistently low (2.5%) among women receiving oxytocin (10 IU) prophylactically, compared with 10.5% when not systematically given. There was wide variation in practice of AMTSL components across hospitals. The low rate of PPH among hospitals administering prophylactic oxytocin was achieved when used alone, as well as when followed by other AMTSL components. Controlled cord traction and uterine massage following no prophylactic uterotonic provided no benefit. Conclusions: Routine use of prophylactic oxytocin was associated with a greatly reduced risk of PPH. The practice of controlled cord traction and uterine massage may warrant further consideration depending on the delivery setting. I94 Human rights implications of maternal mortality E. Durojaye Each year about half a million women, mainly from developing countries, die as result of complications arising from pregnancy. For every woman who dies due to pregnancy complications, ten more suffer other debilitating health conditions While the probability of a woman dying during pregnancy in a country
such as Singapore is about 1 in 3,000, that of her counterpart in Nigeria is about 1 in 16. Maternal mortality has become one of the causes of premature death and morbidity in women of reproductive age in most developing countries. The yearly loss of lives due to pregnancy-related complications is a gross manifestation of inequalities existing between rich and poor nations and between men and women. It also, exemplifies poor leadership, lack of political will and deeply rooted patriarchal traditions that rarely value women’s lives. While deaths associated with pregnancy have almost been eliminated in the developed countries, the reverse is the case in poor countries of the world. Ordinarily, pregnancy ought to be a thing of joy as it heralds the coming of child; however, in most part of developing countries including Nigeria, it has become not only a source of concern but also a nightmare. The causes of death during pregnancy in women are well too known to us. They include hemorrhage, obstructed labour, eclampsia, postpartum sepsis, abortion complications and infected diseases such as malaria, tuberculosis and HIV/AIDS. Moreover, maternal mortality is associated with the three delays – delay in reaching treatment, delay in indentifying the problem and delay in getting treatment; but little efforts have been made by governments in developing countries to address these problems. Hence, women continue to die as a result of preventable or treatable circumstances. This is a very sad, if not embarrassing development, that calls for urgent action. The world does not lack the technologies nor the resources to prevent women from dying as a result of pregnancy, what is lacking is political will. Thus, this paper argues that it is a matter of social injustice to allow women to continue to die from pregnancy-related complications. The UN Human Rights Commission, reiterating the conclusions reached at the ICPD and the Beijing Platform, has noted that the challenge posed by maternal mortality is not only a health problem but also a development and human rights issue. This is because deaths arising from pregnancy-related complications violate women’s fundamental rights to life, reproductive health care, dignity and non-discrimination guaranteed in most human rights instruments Therefore, the Commission calls on states to redouble their efforts in addressing the problem of maternal mortality in their countries. The paper concludes by arguing that unless women’s human rights are taken seriously, then the hope of meeting some of the health-related goals of the MDGs, which include reducing maternal death by three quarters by 2015, will remain a pipe dream in many countries of the world. Government in developing countries must therefore, live up to their obligations to respect, protect and fulfill women’s rights by taking necessary steps to prevent unintentional loss of lives as a result of pregnancy. I95 Using media to mobilise awareness N. Durrell McKenna In societies where cultural traditions are paramount to the stability of the community, visual media can engage and influence politicians, religious leaders, health care professionals and the public. Films in particular bring awareness of the challenges faced by vulnerable women in accessing safe reproductive health care and the consequences of harmful traditional practices. Strategies to eliminate harmful traditional practices to improve reproductive health include: • Increasing awareness at community level • Raising the age of marriage • Ensuring skilled attendants at birth • Providing specialist and emergency back up care This presentation will explore how through film and other visual materials communities and their leaders can be mobilised to address key issues including: • Accessible and affordable maternal and newborn health care • Hygiene and Sanitation
Invited presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S1–S92
few reports of improved perinatal outcome after the introduction of these programmes: in one large series there was a 100% increase in BPI and HIE after training was started in 2000. A recent editorial noted that “Practice does not make perfect, it the practice is wrong”. Simulation based studies have identified common difficulties in the management of SD and when these were incorporated into a training programme there was a 70% reduction in BPI and neonatal fractures. I will review the differences between these discrepant results and the data available from simulation-based studies to identify the ‘active ingredients of effective training’ for Shoulder Dystocia. I92 Available pharmacologic treatment of the overactive bladder H.P. Drutz. Toronto, Canada This presentation will review the current pharmacologic agents available to treat Overactive Bladder (OAB). The incidence, prevalence and differential diagnosis of this condition will be reviewed. The differences in mechanism of action, cardiovascular and cognitive side efeect profiles will be discussed. I93 Understanding postpartum hemorrhage: Its frequency and treatment G. Barrera, J. Blum, M. Cherine, R. Dabash, E. Darwish, B. Dao, B. Dilbaz, A. Diop, J. Durocher1 , I. Dzuba, HT. Kim Chi, W. Leon, I. Medhat, N.T.N. Ngoc, S. Raghavan, B. Winikoff, S. Yalvac. 1 Gynuity Health Projects, New York, USA Background: Recent surveys have shown wide variation in the practice of active management of the third stage of labor (AMTSL) – prophylactic uterotonic administration, controlled cord traction, and uterine massage – and to date, the individual impact of each component on postpartum bleeding has not be adequately examined. Design/Methods: From August 2005–January 2008, two clinical trials were completed in nine hospitals in Burkina Faso, Ecuador, Egypt, Turkey and Vietnam on PPH management. As part of this research, blood loss was measured for over 40,000 vaginal deliveries with calibrated drape for 1-hour postpartum. Sociodemographic characteristics, delivery practices, and pre- and postdelivery hemoglobin levels were documented for each participant. A post hoc analysis was conducted to determine the impact of AMTSL and its components on blood loss and the likelihood to have a PPH. Results/Outcomes: The rate of PPH was consistently low (2.5%) among women receiving oxytocin (10 IU) prophylactically, compared with 10.5% when not systematically given. There was wide variation in practice of AMTSL components across hospitals. The low rate of PPH among hospitals administering prophylactic oxytocin was achieved when used alone, as well as when followed by other AMTSL components. Controlled cord traction and uterine massage following no prophylactic uterotonic provided no benefit. Conclusions: Routine use of prophylactic oxytocin was associated with a greatly reduced risk of PPH. The practice of controlled cord traction and uterine massage may warrant further consideration depending on the delivery setting. I94 Human rights implications of maternal mortality E. Durojaye Each year about half a million women, mainly from developing countries, die as result of complications arising from pregnancy. For every woman who dies due to pregnancy complications, ten more suffer other debilitating health conditions While the probability of a woman dying during pregnancy in a country
such as Singapore is about 1 in 3,000, that of her counterpart in Nigeria is about 1 in 16. Maternal mortality has become one of the causes of premature death and morbidity in women of reproductive age in most developing countries. The yearly loss of lives due to pregnancy-related complications is a gross manifestation of inequalities existing between rich and poor nations and between men and women. It also, exemplifies poor leadership, lack of political will and deeply rooted patriarchal traditions that rarely value women’s lives. While deaths associated with pregnancy have almost been eliminated in the developed countries, the reverse is the case in poor countries of the world. Ordinarily, pregnancy ought to be a thing of joy as it heralds the coming of child; however, in most part of developing countries including Nigeria, it has become not only a source of concern but also a nightmare. The causes of death during pregnancy in women are well too known to us. They include hemorrhage, obstructed labour, eclampsia, postpartum sepsis, abortion complications and infected diseases such as malaria, tuberculosis and HIV/AIDS. Moreover, maternal mortality is associated with the three delays – delay in reaching treatment, delay in indentifying the problem and delay in getting treatment; but little efforts have been made by governments in developing countries to address these problems. Hence, women continue to die as a result of preventable or treatable circumstances. This is a very sad, if not embarrassing development, that calls for urgent action. The world does not lack the technologies nor the resources to prevent women from dying as a result of pregnancy, what is lacking is political will. Thus, this paper argues that it is a matter of social injustice to allow women to continue to die from pregnancy-related complications. The UN Human Rights Commission, reiterating the conclusions reached at the ICPD and the Beijing Platform, has noted that the challenge posed by maternal mortality is not only a health problem but also a development and human rights issue. This is because deaths arising from pregnancy-related complications violate women’s fundamental rights to life, reproductive health care, dignity and non-discrimination guaranteed in most human rights instruments Therefore, the Commission calls on states to redouble their efforts in addressing the problem of maternal mortality in their countries. The paper concludes by arguing that unless women’s human rights are taken seriously, then the hope of meeting some of the health-related goals of the MDGs, which include reducing maternal death by three quarters by 2015, will remain a pipe dream in many countries of the world. Government in developing countries must therefore, live up to their obligations to respect, protect and fulfill women’s rights by taking necessary steps to prevent unintentional loss of lives as a result of pregnancy. I95 Using media to mobilise awareness N. Durrell McKenna In societies where cultural traditions are paramount to the stability of the community, visual media can engage and influence politicians, religious leaders, health care professionals and the public. Films in particular bring awareness of the challenges faced by vulnerable women in accessing safe reproductive health care and the consequences of harmful traditional practices. Strategies to eliminate harmful traditional practices to improve reproductive health include: • Increasing awareness at community level • Raising the age of marriage • Ensuring skilled attendants at birth • Providing specialist and emergency back up care This presentation will explore how through film and other visual materials communities and their leaders can be mobilised to address key issues including: • Accessible and affordable maternal and newborn health care • Hygiene and Sanitation