Beverly Winikoff, M.D., M.P.H. is President of Gynuity Health Projects, a research and technical assistance organization dedicated to the idea that all people should have access to the fruits of medical science and technology development, and Professor of Clinical Population and Family Health at the Mailman School of Public Health, Columbia University. Before starting Gynuity in 2003, Dr. Winikoff was employed for 25 years at the Population Council where she was Program Director for Reproductive Health and a Senior Medical Associate. She developed and managed the Council's Ebert Program on Critical Issues in Reproductive Health, including work on Safe Motherhood, prevention of STDs/AIDS, prevention of unsafe abortion, provision of safe abortion care, and improving postpartum care for mothers and babies. Prior to joining the Council in 1978, she was Assistant Director for Health Sciences, The Rockefeller Foundation. Her work has focused on issues of reproductive choice, contraception, abortion and women's health. She is particularly interested in issues surrounding the abuse, misuse and non-use of medical technology as these phenomena impact on women's health and autonomy.
Dr. Winikoff graduated from Harvard University magna cum laude and earned her M.D. degree from New York University and her M.P.H. degree from the Harvard School of Public Health.
misoprostol for post partum hemorrhage
Principal investigator of a portfolio of work on misoprostol for use in postpartum hemorrhage:
(1) Misoprostol for Prevention of Postpartum Hemorrhage
This double-blinded randomized-controlled trial enrolling 1,600 women in rural Pakistan aims to test whether oral misoprostol reduces the incidence of PPH when administered by trained traditional birth attendants (TBAs) during the third stage of labor.
(2) Misoprostol for treatment of postpartum hemorrhage:
The study is a double-blind, placebo-controlled, randomized trial to compare 800mcg of sublingual misoprostol with oxytocin, the standard first-line treatment in many hospital settings. Sites for this study are: Burkina Faso, Ecuador, Egypt, Turkey, and Vietnam.
(3) Misoprostol as an adjunct treatment for postpartum hemorrhage
In collaboration with the World Health Organization, Gynuity Health Projects is conducting a study of misoprostol as an adjunct treatment to oxytocin for the treatment of PPH. This multi-site, double-blind, randomized controlled trial is being implemented in Argentina, Egypt, South Africa, Thailand, and Vietnam.
Introduction of Medical Abortion in Developing Countries
Projects on this topic are carried out in Asia, Africa, Latin America, Easter Europe/former Soviet Union and the U.S. and include:
? Demonstration projects using medical abortion regimens to introduce the technology in new settings, particularly in places with limited access to legal abortion services
? Studies to inform service delivery protocols for low resource settings
? Collaboration with pharmaceutical companies to facilitate the registration of the drugs internationally;
? Partnering with large nongovernmental organization service providers to introduce medical abortion;
? Creation of policy, sharing of information, and advocacy for medical abortion technologies; and
? Organization of seminars, educational opportunities, and training courses to share information and stimulate interest in the technology?s potential among service providers and other interested colleagues
Misoprostol for Treatment of Miscarriage and Incomplete Abortion
Of all recognized pregnancies, 15 to 20 percent are miscarried or become non-viable in the first trimester of pregnancy. Traditionally, when an early pregnancy is miscarried, treatment is with curettage or vacuum aspiration. Women frequently express a wish for less invasive treatment for this common life event. Misoprostol stimulates uterine contractions and helps to evacuate the uterus. Preliminary studies show that the treatment works in more than 9 out of 10 women. The program of work includes:
? Implementation of clinical trials to gather reliable data on optimal regimen(s) using misoprostol for treatment of early pregnancy failure.
? Creation of regulatory files to register misoprostol for incomplete and missed abortion;
? Development of training and educational materials for policymakers, clinicians, and users; and
? Organization of seminars, educational opportunities and training courses to share information and stimulate interest in misoprostol?s potential for this use.
Work is ongoing in Arica, Latin America, and the former Soviet Union.
Winikoff, B Clostridium sordellii Infection in Medical Abortion Cinical Infectious Diseases 43 2006
Shannon C, Wiebe E, Jacot F, Guilbert E, Dunn S, Sheldon WR, Winikoff B "Regimens of misoprostol with mifepristone for early medical abortion: a randomised trial.” BJOG 113 (6) 621-8 2006
Middleton T, Schaff E, Fielding SL, Scahill M, Shannon C, Westheimer E, Wilkinson T, Winikoff B , “Randomized trial of mifepristone and buccal or vaginal misoprostol for abortion through 56 days of last menstrual period,”
Contraception Vol. 72:5 328-332 2005
Walraven, G., Blum,J., Dampha,Y., Sowe, M., Morison, L. Winikoff, B. Sloan, N. “Misoprostol in the management of the third stage of labour in the home delivery setting in rural Gambia; a randomised controlled trial"
BJOG 112 1277–1283 2005
Winikoff, B. “Pregnancy Failure and Misoprostol — Time for a Change,” editorial, N Engl J Med, 353;8 pp 836-838 2005
Winikoff, B., Ellertson,C., Elul,B., Sivin,I "Acceptability and Feasibility of Early Pregnancy Termination by Mifepristone-Misoprostol: Results of a Large Multicenter Trial in the United States" Archives of Family Medicine 7 1998
Winikoff, B., and Wymelenberg, S. The Whole Truth About Contraception Joseph Henry Press Washington, D.C., 1997
Winikoff, B., Sivin, I., Coyaji,K., Cabezas, E., Xiao, B., Gu,S., Du,M., Krishna, U., Eschen, A. Ellertson, C. "Safety, Efficacy and Acceptability of Medical Abortion in China, Cuba, and India: A Comparative Trial of Mifepristone/Misoprostol vs. Surgical Abortion” American Journal of Obstretrics and Gynecology 176 1997
Winikoff, B., Castle, M.A. and Laukaran V.H., eds. Feeding Infants in Four Societies: Causes and Consequences of Mothers' Choices. Greenwood Press, Inc., Westport, CT 1988
Winikoff, B. "Women's Health: An Alternative Perspective for Choosing Interventions" Studies in Family Planning 19 197-213 1988