Use of oxytocin and misoprostol for induction or ... - POPPHI

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