How to avoid iatrogenic morbidity and mortality while increasing availability of oxytocin and misoprostol for PPH prevention?

Abstract

Guidelines for labor induction/augmentation are needed specifically for low resourced settings. Rigorous studies should be pursued to quantify the magnitude and effect of inappropriate induction and augmentation on maternal and perinatal morbidity and mortality. Programs are needed to ensure community-wide awareness of the adverse effects of the improper use of these drugs on mothers and babies, especially in out-of-hospital settings.

Uterotonic Use at Childbirth in Ghana: A Qualitative Study of Practices, Perceptions, and Knowledge Among Facility-Based Health Care Providers and Community Members

“…Labor induction and augmentation should only be performed by trained health workers in facilities equipped to provide EmOC because of increased risk of obstetric complications accompanying these procedures (Lovold, Stanton, & Armbruster, 2008). Improper administration of uterotonic drugs prior to delivery in peripheral health facilities or by lower-level health workers is considered unsafe because dosage may be difficult to monitor and cannot be adapted to level of uterine stimulation (WHO, 2000).…”

“…In Ghana, the maternal mortality ratio is estimated as 328-350 deaths per 100,000 live births (Lozano et al, 2011;WHO, 2012a), with approximately one-quarter (22%-28%) attributed to hemorrhage ( Asamoah, Moussa, Stafström, & Musinguzi, 2011;Ghana Statistical Service [GSS], Ghana Health Service [GHS], & Macro International, 2009;Martey, Djan, Twum, Browne, & Opoku, 1993). The Ghanaian government has taken steps to improve access to maternal health care and reduce PPH incidence.…”

Special considerations—Induction of labor in low-resource settings

“…A considerable gap in the evidencebased practices includes the lack of well-defined protocols to guide providers in low-resource setting, specifically minimum criteria for staffing and equipment and training on manual rate estimation of oxytocin. 32 Oxytocin is a high-alert medication, with potential complications for both mother and fetus. A key safety measure is the ability to titrate infusion accurately.…”

“…[28][29][30][31][32] It is widely acknowledged that challenges facing maternity wards worldwide include lack of equipment to safely monitor the fetus, a high patient:nurse ratio, leaving many women unattended for long periods of time, and lack of capacity to perform urgent deliveries. Women undergoing IOL require a higher level of care to ensure safe delivery and many maternity units in low-resource areas simply are not adequately staffed or equipped to provide this level of care.…”

Editor's comment

“…One of the interventions, active management of the third stage of labor (AMTSL), concerns the prevention of one of the most common complications (postpartum hemorrhage) [1]. The other intervention, cesarean delivery [2], is in response to several complications.…”