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

Recommendations
1. The collection, compilation and review of data on induction and augmentation
should be added to routine health information systems to address the current
paucity of data on levels and trends. These data are necessary for the
development of effective and context-specific programmatic responses to the
expanded availability of uterotonics, particularly in peripheral health facilities.
2. Evidence-based guidelines should be developed and implemented to address the
appropriate use of uterotonic drugs specifically in low resource settings where
staffing, monitoring and equipment are not conducive to following existing
guidelines as described for high resource settings. These guidelines should
include universally agreed-upon indications for induction and be useful to various
levels of health facilities.
3. Educational materials addressing the use of oxytocin and misoprostol for obstetric
purposes should be specifically designed and disseminated to health care
providers and pharmacists. Such guidelines will likely require a variety of
different formats and means of dissemination; for example, materials addressing
the dangers associated with home-based use of uterotonics for induction and
augmentation which could be used during antenatal care or with traditional birth
attendants, and materials for health care providers, government pharmacists and
private drug sellers regarding the various available uterotonics, their dosages and
appropriate uses.
4. Research is needed into the most effective means of ensuring implementation and
evaluation of these evidence-based guidelines and educational materials.
5. Research is needed on the frequency, methods and outcomes associated with use
of uterotonics and traditional medicines outside of the health care system.
6. The use of misoprostol in low doses for induction has been found to be effective,
safe and practical for use in LDC settings due to its ease of use. Packaging of
misoprostol for obstetric doses of 25mcg for induction, as well as 400-600mcg for
AMTSL should be made available in all LRS settings.
7. Non-pharmacological methods of induction should be explored for use at health
center level for non-urgent and elective inductions as they are inexpensive,
require littlle monitoring and have been shown through systematic reviews to
pose little risk to mother and baby.
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