Does Labor Augmentation with Oxytocin Increase the Risk of Postpartum Hemorrhage? A Randomized Controlled Trial

Mansy, Amr

doi:10.4172/2090-7214.1000268

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…Not surprisingly, the strongest risk factor in our study is requiring manual removal of placenta due to retained placental tissue, which is universally known as the second-leading cause of PPH [34,51]. Augmentation of labor was also supported by many previous observational studies [52,53], as well as being consistent with one randomized control trial, which found that labor augmentation increases the volume of postpartum blood loss [54]. The hypothesized mechanism was the reduction in the uterine contractility after birth due to desensitized oxytocin receptors at the uterus [55].…”

Section: Discussionsupporting

confidence: 87%

Risk Factors for Postpartum Hemorrhage in a Thai–Myanmar Border Community Hospital: A Nested Case-Control Study

Thepampan¹,

Eungapithum²,

Tanasombatkul

et al. 2021

IJERPH

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Postpartum hemorrhage (PPH) is a common complication of pregnancy and a global public health concern. Even though PPH risk factors were extensively studied and reported in literature, almost all studies were conducted in non-Asian countries or tertiary care centers. Our study aimed to explore relevant risk factors for PPH among pregnant women who underwent transvaginal delivery at a Thai–Myanmar border community hospital in Northern Thailand. An exploratory nested case-control study was conducted to explore risk factors for PPH. Women who delivered transvaginal births at Maesai hospital from 2014 to 2018 were included. Two PPH definitions were used, which were ≥ 500 mL and 1000 mL of estimated blood loss within 24 h after delivery. Multivariable conditional logistic regression was used to identify significant risk factors for PPH and severe PPH. Of 4774 women with vaginal births, there were 265 (5.55%) PPH cases. Eight factors were identified as independent predictors for PPH and severe PPH: elderly pregnancy, minority groups, nulliparous, previous PPH history, BMI ≥ 35 kg/m2, requiring manual removal of placenta, labor augmentation, and fetal weight > 4000 gm. Apart from clinical factors, particular attention should be given to pregnant women who were minority groups as PPH risk significantly increased in this population.

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Section: Discussionsupporting

confidence: 87%

Risk Factors for Postpartum Hemorrhage in a Thai–Myanmar Border Community Hospital: A Nested Case-Control Study

Thepampan¹,

Eungapithum²,

Tanasombatkul

et al. 2021

IJERPH

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“…The Lagos pilot study also highlighted lack of guidelines and has helped inform the ongoing advocacy for the relevant stakeholders to address this concern. Currently, most guidelines used in Nigeria are based on experiences and recommendations from the United States, Canada, and the United Kingdom, which have recommended a low dose of oxytocin (2.5IU up to 5IU) intrapartum, with much more caution when being used in multiparous women [ 38 ]. For the prevention of PPH, most guidelines and clinical practice recommend 10IU intramuscular or intravenous [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

A descriptive study of healthcare-providers’ experiences with the use and quality of oxytocin for the prevention of post-partum hemorrhage in Nigeria: A nation-wide survey

Ejekam

Nyangara

Anyakora³

et al. 2021

PLoS ONE

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Background Oxytocin is recommended as an affordable and effective drug in the prevention of postpartum hemorrhage—one of the leading causes of maternal morbidity and mortality in low- and middle-income countries, however, there are concerns about its proper use and quality. This study builds on earlier work conducted in a South-Western state in Nigeria. Objective The study assessed the knowledge around oxytocin, usage, storage practices and perceived quality of oxytocin used by healthcare providers that directly administer oxytocin for the prevention of postpartum hemorrhage across Nigeria. Methods This was a descriptive cross-sectional study that surveyed a representative sample of 6,299 healthcare providers who offer obstetrics and gynecological services and recruited from 1,894 healthcare facilities in Public and Private sectors in 12 states across Nigeria. Data were collected using an electronic questionnaire, analyzed using SPSS, and presented in frequencies and percentages. Results Only forty-six percent of respondents (52.8% in private; 40.0% in public sector) had proper knowledge that oxytocin storage is in the refrigerator. Proper knowledge also varied by professional cadre, doctors (71.2%); nurses (46.6%); Community Health Workers (28.4%) and by years of experience, less than 10 years (51.4%); more than 10 years (40.8%). Only 34% of the respondents (41% in private and 27.5% in public sector) reported good practices that oxytocin is stored in the refrigerator in their facilities. Most healthcare providers used oxytocin for prevention of PPH (77.9%). Oxytocin was also used for augmentation (66.7%) and induction of labor (52.6%). Half of respondents used above the WHO-recommended oxytocin dose of 10IU for prevention of PPH. Twenty-three percent of respondents reported experiencing oxytocin failure in PPH prevention of whom, 54.3% changed to another uterotonic and 37.1% doubled the dose of oxytocin for their patients. Conclusion Our study findings should be used to establish clinical guidelines and trainings for healthcare providers to improve their knowledge and storage practices and use to safeguard the quality of these lifesaving medicines.

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“…Oxytocin when used for labour induction/augmentation can cause both maternal and foetal adverse outcomes [ 2 , 10 ], hence the need for strict adherence to recommendations and adequate provision for close monitoring [ 4 , 7 ]. Oxytocin used during labour has been associated with increased risks of neonatal encephalopathy [ 11 ], and increases the volume of blood loss during vaginal birth [ 12 ]. A Cochrane systematic review has shown that oxytocin used during labour has poor efficacy in reducing rates of caesarean section, and instrumental deliveries and is associated with uterine hyperstimulation and foetal heart rate changes [ 11 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Patterns of oxytocin use for induction and augmentation of labour among healthcare providers in Nigeria

Ejekam,

Okafor,

Okunade

et al. 2024

BMC Pregnancy Childbirth

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Background The practice of intrapartum use of oxytocin for induction and augmentation of labour is increasing worldwide with documented wide variations in clinical use, especially dose administrations. There is also evidence of intrapartum use by unauthorized cadre of staff. Aim This study assessed the patterns – frequency of intrapartum use of oxytocin, the doses and routes of administration for induction and augmentation of labour, and identified the predictors of oxytocin use for induction and augmentation of labour by healthcare providers in Nigeria. Methods This was a cross-sectional study conducted among healthcare providers – doctors, nurses/midwives and community health workers (CHWs) in public and private healthcare facilities across the country’s six geopolitical zones. A multistage sampling technique was used to select 6,299 eligible healthcare providers who use oxytocin for pregnant women during labour and delivery. A self-administered questionnaire was used to collect relevant data and analysed using STATA 17 statistical software. Summary and inferential statistics were done and further analyses using multivariable regression models were performed to ascertain independent predictor variables of correct patterns of intrapartum oxytocin usage. The p-value was set at < 0.05. Results Of the 6299 respondents who participated in the study, 1179 (18.7%), 3362 (53.4%), and 1758 (27.9%) were doctors, nurses/midwives and CHWs, respectively. Among the respondents, 4200 (66.7%) use oxytocin for augmentation of labour while 3314 (52.6%) use it for induction of labour. Of the 1758 CHWs, 37.8% and 49% use oxytocin for induction and augmentation of labour, respectively. About 10% of the respondents who use oxytocin for the induction or augmentation of labour incorrectly use the intramuscular route of administration and about 8% incorrectly use intravenous push. Being a doctor, and a healthcare provider from government health facilities were independent positive predictors of the administration of correct dose oxytocin for induction and augmentation of labour. The CHWs were most likely to use the wrong route and dose administration of oxytocin for the induction and augmentation of labour. Conclusion Our study unveiled a concerning clinical practice of intrapartum oxytocin use by healthcare providers in Nigeria – prevalence of intrapartum use of oxytocin, inappropriate routes of administration for induction and augmentation of labour, varied and inappropriately high start dose of administration including unauthorized and high intrapartum use of oxytocin among CHWs.

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Does Labor Augmentation with Oxytocin Increase the Risk of Postpartum Hemorrhage? A Randomized Controlled Trial

Cited by 4 publications

References 14 publications

Risk Factors for Postpartum Hemorrhage in a Thai–Myanmar Border Community Hospital: A Nested Case-Control Study

Risk Factors for Postpartum Hemorrhage in a Thai–Myanmar Border Community Hospital: A Nested Case-Control Study

A descriptive study of healthcare-providers’ experiences with the use and quality of oxytocin for the prevention of post-partum hemorrhage in Nigeria: A nation-wide survey

Patterns of oxytocin use for induction and augmentation of labour among healthcare providers in Nigeria

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