Advocacy statement on Prevention and Elimination of Cervical Cancer

FOGSI has prepared position statement on covid vaccination for pregnant & breastfeeding women.
Please give your input on FOGSI eMail : [email protected]

  • FOGSI accepts and supports the international consensus regarding female genital mutilation or cutting being a harmful practice and a violation of girls’ and women’s rights to life, physical integrity and health.
  • FOGSI identifies female genital mutilation as a variety of procedures that may involve partial or total, incision, excision or any other injury to the external genitalia that are performed for ritual non-medical reasons. These include but are not limited to clitoridectomy, excision, infibulation and other procedures such as pricking, incising, scraping and cauterizing the genital area. All these procedures are harmful, have no scientific basis or justification and no health benefits whatsoever for girls or women.
  • FOGSI believes that female genital mutilation in any form and to any extent is a cruel traditional practice almost exclusively inflicted on children. It is performed without individual choice or valid consent and by providers without medical training or qualification. This makes female genitalia mutilation a violation of the basic right to physical safety and bodily integrity of girls and women.
  • FOGSI acknowledges the documented medical evidence of the risk of haemorrhage, infection and shock at the time of female genital mutilation, as also long term physical and sexual consequences, including incontinence, infertility, obstetric complications and psychological problems, including serious consequences for sexuality.
  • FOGSI directs its member gynecologists and all other health care professionals to desist from performing or participating in any procedure of female genital mutilation. Any such involvement would clearly be a breach of medical ethics and go against the primary medical dictum ‘to first do no harm’.
  • FOGSI is committed to work with international and national organisations including WHO, FIGO and IMA to confront and condemn female genital mutilation. It is committed to working to change public and professional attitudes and to advocate for eradication of this practice.
  • FOGSI recognizes that violence against women is a serious abuse of human rights. Violence against women commences before birth and continues throughout life in various forms.
  • These range from infanticide, genital mutilation, child marriage, sexual abuse, domestic violence, sex selected abortions, domestic violence, cyber violence, dowry death, honor killing, acid attack, trafficking, physical abuse in situations of conflict and the neglect of the girl child, adolescent and ageing women.
  • Gender discrimination prevents the optimal development and empowerment of girls and women by depriving them of nutrition, education, career opportunities and access to healthcare services making them vulnerable to gender violence.
  • Gender violence has severe physical and psychological health consequences. These include but not limited to unwanted pregnancies miscarriages, low birth weight babies, preterm birth sexually transmitted infections, chronic pelvic pain, depression and suicide, sexually transmitted infections and an increased risk of morbidity and mortality.
  • FOGSI recommends that obstetricians and gynecologists should be aware of violence against women and its impact on women’s health they should acquire the knowledge and skills necessary to identify and provide the first line response and referral to specialized services. FOGSI expects obstetrician and gynecologists to utilize every opportunity to support and empower women, thereby improving their status and health.
  • Our country despite having one of the most liberal laws on abortion still bears a disproportionate brunt of unsafe abortion.
  • It is even more tragic when one considers the technology to provide safe abortions is safe, effective, easy to use and available in our country.
  • The impediments in implementing the present policy for safe abortion care services to women should be addressed and measures taken to facilitate the provision by existing providers.
  • FOGSI has over the years established itself as an institution towards improving the overall health of women and address their unmet needs.
  • Hence FOGSI recommends strategies to train and strengthen the role of existing providers in Comprehensive Abortion Care.
  • FOGSI does not approve the provision of abortions by non allopathic practitioners and nurses.
  • With the current reviews and recommendations in the literature, FOGSI believes that menopausal HT at lowest possible dose and for shortest possible duration is effective for symptomatic relief. Benefits of HRT outweigh risks for symptomatic women before the age of 60 years or within 10 years after menopause.
  • MHT is effective for the prevention of osteoporosis-related fractures in at-risk women before the age of 60 years or within 10 years after menopause.
  • Estrogen alone is appropriate in women after hysterectomy but additional progestogen is required in the presence of a uterus to protect endometrium.
  • In women with premature ovarian insufficiency, systemic MHT should be given at least until the average age of the natural menopause.
  • Local low dose estrogens can be used for Dyspareunia due to dry vagina Venous Thromboembolism and ischemic stroke incidence is lower with transdermal HRT as compared with oral route.
  • The increased risk of breast cancer is primarily associated with the addition of a progestogen to estrogen therapy and related to the duration of use. MHT is not recommended for breast cancer survivors.
  • FOGSI supports the view that the choice of drug(s), dose, route and duration of MHT should be consistent with treatment goals and safety issues and the MHT should be individualized, tailor made and supervised.
  • FOGSI believes that any pregnant women can develop severe life threatening complications necessitating urgent critical care. While many of these may have identifiable high risk factors, others may present in crisis without advance warning.
  • All such women need access to quality health services that can detect and manage life threatening complications thereby averting maternal mortality and morbidity. These services include prompt medical intervention with immediate life saving measures, continuous intensive monitoring, skill based medical and nursing care and multidisciplinary intervention.
  • While critical care in obstetrics is now a specialized discipline practiced in an obstetric Intensive Care Unit (ICU) it is not feasible to have a dedicated obstetric ICU in the varied often low resource settings both in the public and private sector in India. This critical care function may be adequately fulfilled in these situations by an intermediate intensive care High Dependency Unit (HDU).
  • The HDU permits more intensive observation, monitoring, treatment and nursing than is possible in a routine ward, albeit at a level less than that in an ICU. It provides an intermediate standard of intensive care for high risk obstetrics offering a high level of individualised medical care, delivered by trained staff sensitised to understand and manage the unique demands of critical care obstetrics.
  • The ICU is where critically ill patients requiring ventilation or suffering multi organ failure would be managed. The HDU complements the ICU both as a step down unit and by caring for patients, when organ support is not necessary thereby reducing the burden on personnel and resources in the ICU. Besides this the HDU allows a continuum from antenatal through intranatal to postnatal care with the added psychological advantage of family support. Proximity to the newborn permits better lactation and bonding.
  • FOGSI is committed to advocate and work to create awareness and protocols for specialised Obstetric HDUs and trained obstetricians to save critically ill mothers. By this FOGSI aims to reduce the high risk of maternal and perinatal morbidity and mortality associated with these critical medical situations.
  • FOGSI recognizes that violence against women is a serious abuse of human rights besides being a public health issue.
  • The violence commences even before birth with female foeticide and thereafter continues throughout life in various forms, which range from female infanticide, female genital mutilation, child marriage, dowry death, honor killing, acid burning, trafficking, sexual abuse, domestic violence, gender discrimination, physical abuse in armed conflict and deliberate neglect of young girls and ageing women. It needs to be stressed, that even though it is underreported, millions of women experience violence or are living with its consequences.
  • As a leading Organization dedicated to women’s health, which includes physical, mental and sexual well being, FOGSI is extremely disturbed at the growing prevalence of violence against women.
  • Gender discrimination prevents optimal development and empowerment of women by depriving them of adequate nutrition, education and access to healthcare services. Gender violence leads to not only severe physical and mental health implications but also unwanted pregnancies, miscarriages, sexually transmitted infections including HIV and AIDS, adverse sex ratio in society and increased morbidity and mortality amongst women.
  • FOGSI is committed to empowering the youth by promoting sexual and reproductive health through education and advocacy.
  • We believe that women should be made aware of their rights so as to make their own choices, should have access to health care services wherever they live, across the whole spectrum of needs and should be encouraged to be financially independent.
  • As an Organization, we object to harmful traditional practices and improper use of modern technology. In India, as gynecologists, we occupy a very unique position in society which gives us the opportunity to empower women using various strategies, which will ultimately improve the status and health of women in India.
  • FOGSI understands the importance of progestogen only pills as an effective form of birth control in women.
  • In the first six months of the postpartum period when combined pills are not recommended, progestogen only pills (POP) are an effective contraceptive option. This is also appropriate in situations when estrogen-containing pills are contraindicated or when a client is estrogen-sensitive. Apart from the post partum period, women may also be offered POPs when they cannot tolerate the side effects of estrogen.
  • FOGSI underlines the importance of counseling for all methods of contraception, inclusive of POP users.
  • FOGSI believes that compliance would improve with counseling especially when the common problems of menstrual irregularities are highlighted.
  • FOGSI recognizes that the postpartum period provides a unique opportunity to address the unmet need in contraception and adopt reliable contraception methods. With an increase in the number of institutional deliveries, postpartum intra uterine device (PP IUD) insertion is an opportunity which when well utilized provides women with an option of effective long-term birth control.
  • FOGSI believes that counseling for a range of postpartum contraception should take place in the antenatal period. If the woman opts for the postpartum IUD, an informed choice should ideally be obtained for the same.
  • To maximize the efficacy and reduce the IUD expulsion rate, it is necessary for health care providers to be trained in recommended insertion techniques both after a normal delivery and a caesarean section.
  • FOGSI supports the training of health care providers in insertion techniques and counseling on postpartum contraception with a focus on long-term methods like the PP IUD.
  • FOGSI recognizes that meeting a woman’s contraceptive needs at all stages of their reproductive life is a vital aspect of quality reproductive health care. Special considerations must be included while providing care during the post-partum and post abortion period.
  • FOGSI believes that contraception alone cannot eliminate the need for access to safe abortion services. Women undergoing induced abortions remain at risk of unintended pregnancy since return to fertility could be as early as two weeks following abortions. Therefore efforts must be made to counsel and provide post – abortion contraception and address the unmet need for family planning.
  • Contraceptive counseling and universal access to modern methods of family planning including barrier contraception, combined hormonal contraception, long acting hormonal contraception including injectables, progesterone only contraception, intrauterine contraceptive device, permanent methods of male and female contraception should be offered in post abortion care services. The basket of choice should also include emergency contraception.
  • FOGSI reiterates that women and men must have the freedom to choose, accept or refuse post abortion contraception without any condition or coercion.
  • FOGSI is committed to ensure 100% antenatal voluntary counseling and screening for HIV/AIDs and 100% coverage of pregnant women with “FOGSI guidelines for screening and prevention of vertical transmission” (prevention PMTCT strategy) by FOGSI members.
  • By doing this FOGSI believes that vertical transmission of HIV can be reduced to less than 1-2% (at par with any developed country).
  • For this the awareness and sensitivity about PMTCT must be increased amongst general population.
  • It is also important to ensure post-exposure prophylaxis services to all FOGSI members through adoption of “safe work practice guidelines” and through the “FOGSI PEP help line”, which will remove the dread amongst obstetricians about HIV.
  • FOGSI acknowledges the existence of gender violence in the community and abhors these injustices meted out to women.
  • Every FOGSIAN is sensitive to this and other issues relating to domestic violence and is on guard regarding the same being encountered in his or her day to day clinical practice.
  • The gynecologist will identify, assess, counsel and address such an issue.
  • FOGSI opposes any kind of media display be it through movies, TV programmes, news papers, magazines or websites which is gender based and trivializes women.
  • FOGSI offers to join hands with stakeholders to offer technical assistance and guidance to establish Adolescent Friendly clinics and centres.
  • FOGSI appreciates the importance of empowering the adolescent population with the knowledge of life style skills which include sexuality, contraception, STDs, gender violence and general health care measures.
  • Hysterectomy is a surgery where in the uterus is removed for different indications for the health of women.
  • Women need to be counseled about pros and cons related to removal of uterus and ovaries, pelvic floor defects and different routes of removal of uterus (abdominal, vaginal and laparoscopic) before deciding on the removal of uterus in reference with anticipated menopausal symptoms and signs.
  • Hysterectomy demands a sound knowledge about the science related to the removal of uterus and ovaries and pelvic floor defect identification and correction both before removal of uterus and as also its effects after repair is performed.
  • This can be offered best by gynecologists and surgeons can be called in the event of involvement of other organs and to assist in difficult situations.
  • In case of a cesarean section the surgeons may perform these procedures as life saving measures in the absence of a gynecologist.
  • FOGSI believes that non gynecologists (including surgeon) cannot do justice to the science of removal of uterus or to operative deliveries since these are not just surgical skills and training for them is primarily imparted to gynecologists.
  • FOGSI recognizes the right of a woman to terminate the pregnancy beyond 20 weeks when there is a substantial risk that if child were born, it would suffer from such physical or mental abnormalities to be seriously handicapped.
  • These terminations should be done for specific medical reasons.  
  • The FOGSI takes into account the current position of law and strongly recommends necessary amendment to the law.
  • FOGSI believes there is an immediate need to promote male contraceptive methods which are languishing in India.
  • Non Scalpel Vasectomy (NSV) is perceived by FOGSI as an effective method of permanent contraception for men.
  • It should be offered as an alternative method when counseling for permanent sterilization
  • FOGSI acknowledges the fact that this method is safe, minimally invasive and effective.
  • FOGSI endorses contraceptive implants as an efficient, reliable, long term method of contraception.
  • It is an alternative for women who prefer not to think about birth control every day, week or month and has effectiveness independent of user behavior.
  • As these are sub dermal implants, the training of the provider is very essential and the technique of insertion, although simple, needs to be learnt by providers before they attempt first insertion.
  • The training also enables the provider to counsel women on the benefits and side effects associated with implant use, to select appropriate users and the correct time of insertion.
  • FOGSI believes that implants are a promising, effective method of contraception and that should be available as an option for contraception.
  • FOGSI recognizes the scientific evidence supporting the use of long acting injectable progestogens as a safe, effective, reversible, long acting method of contraception.
  • Long acting injectable progestogens as a contraceptive method have been used since over two decades and are available worldwide in more than a 100 countries.
  • The advantages of long acting injectable progestogens are that they are a highly effective, safe, long acting and easy to administer and use method of contraception, a feasible option when estrogen-containing contraceptives are not favored or medically contraindicated and with no adverse effects on lactation.
  • For women they provide autonomy and choice with privacy about their use easily maintained and as a reversible method which can be discontinued without having to seek provider assistance.
  • Concerns regarding menstrual disturbance and osteoporosis can be addressed by counseling while those involving risk of malignancy have no proven scientific basis.
  • FOGSI believes that long acting injectable progestogens are an important component of the contraceptive choices which should be available to the women of our country through both the private and the public sector.   
  • FOGSI acknowledges the female condom as an effective form of barrier contraception, offering women choice, autonomy and control as well as the prevention of STIs.
  • FOGSI appreciates that it has been shown to be effective in prevention of pregnancy and is accepted by users but has yet to achieve its full potential in national programs because of a relatively high cost.
  • FOGSI appreciates that it is an important complementary technology that must be given a more prominent place in reproductive health programs with a potential to save the lives of millions of women and men.
  • FOGSI believes that if high utilization rates of this new device can be achieved, it will make a substantial contribution in preventing of unwanted pregnancies and STIs, including HIV.
  • FOGSI believes that surrogacy is needed by many issueless couples and should be legalized in India.
  • There should be a legal contract between the surrogate and the commissioning couple keeping in mind the various issues arising out of such a deal and keeping in mind the interest of all concerned with the rights of the surrogate, rights of the commissioning couple and rights of the child to be of prime consideration.
  • The age of the commissioning couple should not be more than 55yrs, whereas the surrogate should not be more than 35 years. The surrogate can be a relative or a person known or unknown to the commissioning couple.
  • In case of NRIs and foreign couples, commissioning couple should get a certificate from their country on the citizenship rights of the baby born out of such arrangement and a local guardian should be appointed legally to ensure that the surrogate is taken care of during pregnancy and delivery. Role of the local guardian should be defined in case of any mishap during pregnancy or delivery and thereafter.
  • There should be clear guidelines in the contract about addressing issues such as the situation of the child if one of the commissioning couple dies, custody of the child if the couple is divorced, care and responsibility of complications of pregnancy in the surrogate and if the surrogate dies in child birth the provision of adequate compensation.
  • FOGSI recommends that the surrogate should be insured wherever feasible.
  • Similar sex couples should be allowed to have a baby through a surrogate, using donor egg or sperm, provided all the issues cropping up from such arrangements are discussed and a legal contract charted including the rights of the child in case of divorce or death of a partner.
  • The surrogate should have no right to the child as such and must relinquish the baby to the commissioning parents.
  • That all legal issues be handled by a special court with members from judiciary, FOGSI and society.
  • FOGSI believes that girls and women of all ages be offered vaccination to protect them from various infections.
  • It is now possible to avoid majority of infectious diseases by vaccination.
  • This vaccination is to be offered based on the FOGSI guidelines.
  • Neonatal resuscitation at the time of birth is important and vital for the long term well being of the neonate.
  • FOGSI appreciates the need that the members be well equipped with the knowledge of neonatal resuscitation and update themselves regularly in this regard and endorses the need that the delivery facility be adequately equipped with neonatal resuscitation facilities.
  • FOGSI approves of the Golden First Minute Project (GFMP) which highlights that neonatal resuscitation provides maximum benefit when implemented in the first minute of birth and consists of simple neonatal resuscitation steps.
  • FOGSI encourages its members to display the GFMP flow chart in the delivery room.
  • Our country despite having one of the most liberal laws on abortion still bears a disproportionate brunt of unsafe abortion.
  • It is even more tragic when one considers the technology to provide safe abortions is safe, effective, easy to use and freely available in our country.
  • The primary reason for it is the limited number of trained healthcare providers authorized to offer safe abortion care services to women as and when needed. This means that women who need safe abortion services are unable to access it.
  • FOGSI has over the years established itself as an institution towards improving the overall health of women and address their unmet needs.
  • Hence FOGSI recommends strategies to strengthen the role of non allopathic physicians and qualified non physicians in Comprehensive Abortion Care.
  • FOGSI recognises the universal practice of the off – label use of a drug or treatment, where the clinical indication for using it is different from that which it was formally approved for.
  • It is recommended that such off – label use should be supported by evidence based experience reported in medical literature.
  • It must however be stressed that off – label use should be undertaken after informing the patient regarding the advantages, disadvantages and risks of such use.
  • FOGSI confirms WHO Guidelines and believes that low dose hormonal contraceptive pills are safe, effective and convenient form of contraception to meet the unmet needs of contraception and thereby reduce the maternal morbidity and mortality due to unwanted pregnancies.
  • Extensive trials have proven that the method is reversible with additional health benefits.
  • FOGSI advises its members to use the newer low dose hormonal contraceptive pills. 
  • FOGSI acknowledges that the widespread availability of emergency contraception can reduce considerably the incidence of unwanted pregnancy with a consequent reduction in unsafe abortions, maternal morbidity and mortality.
  • Government of India and FOGSI believe that emergency contraception deserves to be a part of reproductive health care services to avoid unplanned pregnancy and associated health benefits. Proper counseling regarding menstrual irregularity will improve the compliance.
  • FOGSI believes that meeting the unmet needs in contraception will play a vital role in population stabilization and endeavors to promote all birth spacing methods such as barrier contraceptives, intrauterine devices and hormonal contraceptives without compromising the importance of permanent methods like tubal ligation and vasectomy.
  • FOGSI is committed to disseminate awareness of and incorporate recent developments such as newer oral contraceptives and emergency contraception as also to dispel myths and faulty beliefs related to contraception.
  • FOGSI supports the individual’s right to make reproductive choices and decision without coercion and recognize the need to enhance responsible male participation and believes this is the need of the hour.
  • FOGSI confirms the WHO Guidelines and believes that injectable hormonal contraceptives are a safe, effective and convenient form of contraception particularly for lactating and estrogen sensitive women.
  • Extensive trials have proven that the method is reversible with additional health benefits.
  • Proper counseling regarding menstrual irregularity will improve the compliance.
  • FOGSI advises its members to use injectable hormonal contraceptives within the WHO Guidelines.
  • FOGSI recognises the universal evidence on the effectiveness and safety of mifepristone – misoprostol for inducing Medical Termination of Pregnancy up to 64 days as approved for use by the Drug Controller of India.
  • It needs to be stressed that under the existing laws they can only be administered by Gynecologists and Registered Medical Practitioners recognized for performing MTPs by the MTP Act of 1971.
  • FOGSI recommends close monitoring of distribution and mode of use of these drugs and the medical profession and the medical profession and the pharmaceutical industry exercise due diligence in their promotion and use.
  • It is also vital that consumers be educated regarding this recently introduced method its advantages, drawbacks, risks and limitations.
  • Resolved that the FOGSI is quite against performing the Chorion Biopsy on the basis of Sex Determination and further FOGSI strongly disapproves selected MTP for unwanted sex of existing pregnancy.
  • However FOGSI feels that his method is good if done purely to diagnose genetic disorders in the embryo.

FOGSI’s proposed Position statement on Adolescent Health Education and a need of Dedicated Adolescent Clinics – A call to Action from FOGSI

Adolescence is a phase of major transition from childhood to adulthood. Adolescents are future citizens and future parents, hence need special care. India is the youngest country of the world. About 21% of Indian population is adolescents (about 243 million). Since adolescence and teenage is the most important age in shaping ideas and attitudes that will form the base of a healthy and happy nation.

They need to know Preventive adolescent healthcare aspects like, Anaemia, obesity, PCOS, Sexually Transmissible Infections and HIV/AIDS, Personal Hygiene, Menstruation problems, Nutrition, Psychological problems, internet & substance abuse etc. They need to know how to say NO to sexual abuse, drugs, & alcohol abuse. They need to learn lifestyle modifications. FOGSI advocates for Preventable Adolescent healthcare education, which can go a long way in keeping the nation clean and healthy.

FOGSI advocates to provide adolescents with comprehensive sexuality education (CSE) in an age and developmentally-appropriate manner. There is a significant gap in the availability of authentic age-appropriate information and care for adolescents and young adults. Schools and teachers are in a unique position to fill this gap. FOGSI intends to advocate and roll out a program which will empower and enable the provision of this information.

Early puberty, nuclear families, academic pressure, urbanisation, globalisation, explosion of technology, internet/mass media/smart phones may lead to adverse influence. Malnutrition /obesity, anaemia, road traffic accidents, depression, suicide, violence, sexual abuse, alcohol/tobacco/drugs consumption, early pregnancy, unsafe abortions, HIV/ STDs are commonly seen in adolescents. Investing in their health have long term benefits.

Regular health services & clinics may be unfriendly towards youngsters. There may be barriers of high cost, unwelcoming services, gender discrimination, fear of disclosure etc. They have many queries and problems but they do not find a proper faithful place for interaction and to get solutions to their problems. Hence FOGSI recommends establishing dedicated Adolescent clinics where trained health care workers will provide quality health care to youngsters and to ensure that all levels of health workers, including support staff, respond to adolescent clients effectively and with sensitivity. Their privacy & confidentiality will be maintained. Attitude of the care providers will be friendly & non-judgemental. Promotive, preventive, curative, referral, informative & outreach services will be provided. Thus physical, mental, social and sexual health of adolescent girls and boys will be looked after.

FOGSI believes the conflation between POCSO and the MTP Act should be removed. POCSO Act needs to recognise adolescent sexuality. It therefore follows that the MTP Act needs to provide for safe abortions for adolescents and needs to increase the gestational limits as a large number of adolescents or children who face abuse, recognise the pregnancy late and thus present later. 

FOGSI’s Proposed Position statement on Importance, Need and Use of Blood Components in Obstetrics

Blood transfusion (BT) practice is an essential and important aspect of High-risk pregnancy and critical care in obstetrics.BT in obstetrics can be a lifesaving intervention. In the countries of the SEA Region, obstetric cases need blood most. 30% blood was used for obstetric cases. (WHO, 2010). It is estimated that collection of blood in the Southern East Asia is about only half the demand. In most of the countries of the region, whole blood is used, irrespective of the clinical indications. (WHO, 2010)

Purpose of Transfusion is REPLACEMENT and/or THERAPUTIC-to restore intravascular volume with whole blood or its products, to restore the oxygen capacity of blood by replacing red blood cells, to replace clotting factors and correction of anaemia.Whole blood can be used as it is, or is separated into “blood components”.Types of common blood components are Red blood cell concentrate (packed red blood cells, Platelet concentrate, Fresh frozen plasma, Cryoprecipitate, separated by differential centrifugation.

FOGSI believes that the use of whole blood is an unscientific, inefficient, unhealthy and criminal waste of a valuable resource. Storage Requirement for Blood components is different. Whole Blood is stored at 4-6° C, Red Cells at 4°C, Platelets at 22-24° C (On Shaker), FFP at -20 to -30° C, Cryoprecipitate is stored at -20°to -30 C.So when whole bold is used, the components which should be stored at different temperature become inefficient and nonviable. It is a wrong assurance that by giving whole blood, all the blood components are replaced.

The Shelf life of each component is also different. ForRed cells it is- 35-40 days, for FFP/CPP – 1 year, forPlatelets – 5days, for CRYO- 1 Year and for White blood cells- 2 days.When whole blood is used for rising of Hb%, which can be achieved by Packed RBCs, the components which could have beenseparated out and stored, are wasted in an unindicated patient. Compare to whole blood (approximately 350 ml), Packed Red Cells has low volume(approximately 250ml)which can prevent circulatory overloading problem and complications because of plasma when more units of blood are required.

When acute massive blood loss occurs, it can lead to Hypovolemia, Hypoxia, deficiency of clotting factors, deficiency of Platelets occurs. All these Problemshave different solutions and allow us for different optimum time for it’s correction. Plasma Expanders require for Hypovolemia, Packed RBCs for Hypoxia,FFP for Clotting Factors, Cryoprecipitate for Clotting Factors deficiency and for low platelet -PRC / PRP is required. Whenthere is massive blood loss, we need to correctPlatelet deficiency asap within (<1-2 hours), coagulation defects within 2-4 hours, hypovolemia within 6-12 hours and hypoxia within 6-12 hours. Whole blood is not rational for better patient managementas concentrated dose of required componentis required to avoid circulatory overload, to tackle the different problem caused by massive blood loss priority wise,to minimize transfusion related complications and to decrease cost of management.For Blood Component Therapy in Obstetric Emergency, two I.V. lines can be taken. In one I.V. line, platelets, cryoprecipitate and FFP can be given and in 2nd I.V. line, PCV can be given. Patient can be monitored Hb, Platelet count, PT.In patients likely to need massive transfusion, begin resuscitation with blood products as soon as possible to prevent dilution coagulopathy.Administer blood products in a ratio of 4 units PRBC: 4 units FFP: 4 units PLT: 4 units of cryoprecipitate. This is known as massive blood transfusion protocol. (MTP) FOGSI recommends following Hb level during pregnancy at which Packed red blood cell transfusion can be considered. In antepartum, intranatal, postnatal and in acute blood loss when Hb<7 gm%, in post-operative period when Hb < 8.0gm%, in critically ill obstetric patient when Hb < 9.0gm% or when patient is having signs of cardiac failure or hypoxia or hemodynamically unstable, Packed RBCs can be given. If the Hb is less than 7–8 g/dl in postnatal period and where there is no continuing or threat of bleeding, in otherwise healthy, asymptomatic patients, there is little evidence of the benefit of blood transfusion.(RCOG Green-top Guideline). In such patients, parenteral iron is useful and can be considered. FOGSI believes (1) There is no role of whole blood in modern obstetrics unless components are not available or in war. The collected blood should be separated into its components and used in conditions with specific requirements for it’soptimal utilization. (2) For the management of only anaemia, for Hb rise, Packed RBCs should be used instead of whole blood. (3) Blood should be used only in those conditions when equally effective alternatives cannot be used. A blood transfusion should never be ordered unless it is worth the risk.(4) Single unit transfusion has no significant therapeutic benefit.(5)Use of fresh blood – should be avoided because of increased risk of infections (TTI), unless it is emergency and only stored screened blood is to be used. (6) In appropriate cases, it is advisable to keep matched blood ready in blood bank. (7) It is advisable to take a separate and specific consent for blood transfusion FOGSI advocates for a facility of separation and availability of blood components minimum at all the medical colleges and all the district hospitals and Transportation and Storage facility of blood components at all the Taluka places across India. The aim is to reduce unnecessary blood transfusions, promoting the proper use of blood and blood components and to minimise it’s complications. No one should die because of non-availability of blood and no one should die because of improper blood transfusion practice. BLOOD TRANSFUSION SAFTEY IS THE PRIORITY.