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How to avoid iatrogenic morbidity and mortality while increasing availability of oxytocin and misoprostol for PPH prevention?
Author(s) -
Lovold Ann,
Stanton Cynthia,
Armbruster Deborah
Publication year - 2008
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2008.08.009
Subject(s) - misoprostol , medicine , labor induction , oxytocin , obstetrics , adverse effect , pregnancy , induction of labor , intensive care medicine , abortion , pharmacology , genetics , biology
Objective Increased availability of oxytocin and misoprostol is needed to reduce the risk of postpartum hemorrhage. This review compiles rates and risks of adverse maternal and perinatal outcomes associated with use of these medications for labor induction and augmentation in low‐income countries. Recommendations are proposed based on the findings. Methods We did a structured literature review using 5 databases followed by analysis of induction and augmentation rates from existing data. Results Combined induction and augmentation rates were documented in up to 50% of hospital‐based deliveries identified in the databases. Data are sparse but suggest associations between induction/augmentation and stillbirth, neonatal resuscitation, and uterine rupture, and inappropriate administration of oxytocin and misoprostol both outside and inside healthcare systems in low‐income countries. Conclusions 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.