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

adverse outcomes of induction because the indication for Cesarean may well have been
due to the pre-existing medical condition of the mother or fetus. Therefore, we are
unable to compare these results to those presented for HRS. Two of the studies from
Nigeria and Tanzania compare rates of Cesarean section following oxytocin or
misoprostol induction and found that Cesarean section rates were lower among the group
using misoprostol compared to oxytocin groups (96, 99)
Ruptured uterus, a disastrously poor outcome of labor, is still all too common in
developing countries, although virtually eliminated in developed countries and has been
associated with use of induction and augmentation. A group of studies reviewing cases
of ruptured uterus for etiology found induction or augmentation associated with two to 44
percent of the cases of ruptured uterus (26, 27, 33, 103, 104). Al-Jufairi cited an odds
ratio of 2.7 if excessive oxytocin is used or if oxytocin is used with a previous Cesarean
(8) In a study of uterine rupture in Sudan, Ahmed found inappropriate use of oxytocin as
the cause of 10.5 percent of uterine rupture cases (7).
Oxytocin use before birth has also been documented at home-based deliveries that are not
attended by a medically skilled provider. For example, when interviewing 600 women in
rural India who had delivered at home, Sharan and colleagues found that 22 percent of
them reported an injection of oxytocin during labor (10). They also found that when
interviewing traditional birth attendants, several stated that they would recommend the
injection to women to hasten labor. In the Sudan, Ahmed reported that in six of 86 cases
of uterine rupture, the woman had received oxytocin at home (7).
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