11 New Sexual and Reproductive Health Guidelines and Technologies Sharon Phillips, Lisa Thomas, Lale Say 31 May 2013

22 To help people lead healthy sexual and reproductive lives Mission of HRP The attainment by all peoples of the highest possible level of sexual and reproductive health Vision statement

3 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 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

44 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 Filename

55 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 Filename

66 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 Filename

77 WHO Recommendations for prevention and treatment of pre-eclampsia and eclampsia  Released 2011  New recommendations on use of magnesium sulfate and antihypertensive drugs Filename

88 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 Filename

99 Safe abortion: Technical and policy guidance for health systems  Released 2012  New recommendations on medical abortion and management of incomplete abortion Filename

10 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 Filename

11 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 11

12 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. Filename

13 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. Filename

14 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) Filename

15 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… Filename