Unregulated usage of labour-inducing medication in a region of Pakistan with poor drug regulatory control: characteristics and risk patterns

Abstract

BackgroundIn developing countries such as Pakistan, poor training of mid-level cadres of health providers, combined with unregulated availability of labour-inducing medication can carry considerable risk for mother and child during labour. Here, we describe the exposure to labour-inducing medication and its possible risks in a vulnerable population in a conflict-affected region of Pakistan.MethodsA retrospective cohort study using programme data, compared the outcomes of obstetric risk groups of women treated with unregulated oxytocin, with those of women with regulated treatment.ResultsOf the 6379 women included in the study, 607 (9.5%) received labour-inducing medication prior to reaching the hospital; of these, 528 (87.0%) received unregulated medication. Out of 528 labour-inducing medication administrators, 197 (37.3%) traditional birth attendants (also known as dai) and 157 (29.7%) lady health workers provided unregulated treatment most frequently. Women given unregulated medication who were diagnosed with obstructed/prolonged labour were at risk for uterine rupture (RR 4.1, 95% CI: 1.7–9.9) and severe birth asphyxia (RR 3.9, 95% CI: 2.5–6.1), and those with antepartum haemorrhage were at risk for stillbirth (RR 1.8, 95% CI: 1.0–3.1).ConclusionsIn a conflict-affected region of Pakistan, exposure to unregulated treatment with labour-inducing medication is common, and carries great risk for mother and child. Tighter regulatory control of labour-inducing drugs is needed, and enhanced training of the mid-level cadres of healthcare workers is required.

Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study

“…This is similar to studies from Bangladesh and Pakistan, where misuse of oxytocin was associated with stillbirth and birth asphyxia [36, 37]. Notably, the Pakistani study draws attention to the danger of insufficiently trained healthcare workers administrating this highly potent drug [36]. …”

Stillbirths

“…As in HICs, some proportion of stillbirths is associated with uterine hyperstimulation during induction or augmentation of labor. 36 Although stillbirths from this cause have mostly been eliminated in HICs due to fetal monitoring and rapid access to cesarean section, in LMICs where fetal heart rate monitoring is not available, stillbirths from this cause may be common but data to evaluate this issue are not available.…”

Where technology does not go: specialised neonatal care in resource-poor and conflict-affected contexts

“…In other studies in resource-poor settings, reasons for parents/care givers opting for discharge against medical advice have been found to be mainly financial; 21 however, in the context of the free health care provided by MSF, this needs to be better understood. Potential reasons for this occurring in our sites may be conflicting parental/care giver priorities (for example, the mother being expected to be at home to take care of the rest of the family), lack of space in units leading to a pressure to turn over beds rapidly, and a lack of training of the clinicians on the risks of early discharge.…”