Use of oxytocin and misoprostol for induction or ... - POPPHI
Use of oxytocin and misoprostol for induction or ... - POPPHI
Use of oxytocin and misoprostol for induction or ... - POPPHI
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1. Introduction<br />
Low <strong>and</strong> middle income countries are burdened with high maternal <strong>and</strong> perinatal<br />
m<strong>or</strong>tality <strong>and</strong> m<strong>or</strong>bidity <strong>and</strong> face the challenge <strong>of</strong> addressing these problems with very<br />
limited personnel <strong>and</strong> material resources (1). Given that across all low income countries<br />
the annual per capita investment in health is only US $23 (2), establishing high quality<br />
clinical practices that are evidence-based <strong>and</strong> cost-effective is critical. Where health care<br />
needs are dire <strong>and</strong> resources inadequate, elective procedures are not justifiable. M<strong>or</strong>e<br />
imp<strong>or</strong>tantly, even highly cost-effective interventions when improperly administered, may<br />
result in serious adverse outcomes. Induction <strong>and</strong> augmentation <strong>of</strong> lab<strong>or</strong> are examples <strong>of</strong><br />
two such interventions <strong>and</strong> are the focus <strong>of</strong> this w<strong>or</strong>king paper.<br />
The impetus <strong>f<strong>or</strong></strong> a w<strong>or</strong>king paper review on the use <strong>of</strong> uterotonic drugs <strong>f<strong>or</strong></strong> <strong>induction</strong> <strong>and</strong><br />
augmentation <strong>of</strong> lab<strong>or</strong> was a concern following recent calls <strong>f<strong>or</strong></strong> exp<strong>and</strong>ed availability <strong>of</strong><br />
<strong>oxytocin</strong> in low resource setting (LRS) health facilities to promote active management <strong>of</strong><br />
the third stage <strong>of</strong> lab<strong>or</strong> (AMTSL) <strong>f<strong>or</strong></strong> the prevention <strong>of</strong> postpartum hem<strong>or</strong>rhage (3)(4).<br />
Expansion in the availability <strong>of</strong> uterotonic drugs <strong>f<strong>or</strong></strong> AMTSL will require increased<br />
attention to the safe <strong>and</strong> appropriate use <strong>of</strong> these drugs <strong>f<strong>or</strong></strong> other purposes in LRS where<br />
the number <strong>of</strong> protocols, staff, equipment, training <strong>and</strong> supervision may be limited.<br />
Table 1.1a lists examples <strong>of</strong> inappropriate uses <strong>of</strong> <strong>induction</strong> <strong>and</strong> augmentation, including<br />
anecdotal examples collected by PATH staff members, the auth<strong>or</strong>s <strong>of</strong> this review, <strong>and</strong><br />
examples from published literature.<br />
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