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New Sexual and Reproductive Health Guidelines and Technologies

Sharon Phillips, Lisa Thomas, Lale Say

31 May 2013

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To help people lead healthy To help people lead healthy

sexual and reproductive livessexual and reproductive lives

Mission of HRPMission of HRP

The attainment by all peoples The attainment by all peoples

of the highest possible level of of the highest possible level of

sexual and reproductive healthsexual and reproductive health

Vision statementVision statement

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Department of Reproductive Health and Research (RHR), includingUNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research,

Development and Research Training in Human Reproduction (HRP)

Marleen Temmerman, Director

• 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

• 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

Adolescents and at-Risk Populations Team

Lale Say, Coordinator

• 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.

Maternal and Perinatal Health and Preventing Unsafe Abortion Team

Metin Gülmezoglu, Coordinator

• Maternal and perinatal health• Prevention of unsafe abortion• Pre-conception / pre-pregnancy

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WHO recommendations for the prevention and treatment of post-partum haemorrhage (PPH)

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

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

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

Released 2011 New recommendations on

use of magnesium sulfate and antihypertensive drugs

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Prevention and treatment of pre-eclampsia/eclampsia

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

Released 2012 New recommendations

on medical abortion and management of incomplete abortion

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Safe abortion care

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

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

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

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, moderate-quality evidence)

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Uterine care

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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