Prevalence of use of highly concentrated oxytocin or “pepper injection” in labor among clinicians undergoing emergency obstetric training in Sierra Leone

Abstract

Objective: To examine the awareness, prevalence of use, and knowledge of risks of pepper injection (PI), an injection of highly concentrated oxytocin used to augment or induce labor, among clinicians. Methods: An anonymous pre-and post-workshop evaluation conducted among 227 clinicians participating in emergency obstetric and newborn care training in Sierra Leone from June to October 2018. Results: Overall, 225 participants completed the surveys. Of these, 198 (88.0%) of clinicians reported awareness of PI, and 123 (54.7%) self-reported prior use, which was highest among midwives (94/129; 72.9%). Before EmONC training, 82 (36.4%) clinicians reported that they were likely to use PI; this decreased to 39 (17.3%) after training (P<0.05). The mean number of participants correctly identifying risks of PI increased from 149 (66.2%) to 204 (90.7%) after training (P<0.05). Conclusion: There was widespread awareness of PI use among clinicians, and prevalent self-reported prior use among midwives. Risk awareness improved after EmONC training, and the proportion of clinicians reporting likelihood of future use decreased. Improper use of oxytocin may be a major contributor to maternal and newborn morbidity and mortality in Sierra Leone. Initiatives to educate clinicians and to regulate and stop the practice are needed.

Oral misoprostol alone compared to oral misoprostol followed by oxytocin in India: a multicentre randomised trial in women induced for hypertension of pregnancy.

“…The simplicity of the LDOM protocol could also have adverse consequences if it encouraged labour induction or augmentation in the community or by unskilled birth attendants. There have been reports of adverse outcomes from unauthorised intrapartum use of both oxytocin and misoprostol in the community, 17,18 and the rate of adverse events is likely to be worsened by the frequent confusion over dosage and routes for both agents. National health care regulators should ensure that the public and informal health care workers are informed about the risks of unregulated use of misoprostol in labour, so that woman and their babies are not put at risk.…”