Uterotonics


	Community of Practice
	Uterotonics

Welcome to the Uterotonics Community of Practice! This newly-established, interactive CoP is a work-in-progress. Although it already houses a number of useful resources and links, we know that it can only reach its full potential with your help and contributions. It is our hope that the Community will come together to help make this online resource as relevant and helpful as possible.

In order to foster dialogue among experts in specific sub-fields of maternal health, the Maternal Health Task Force has helped convene communities of practice around certain issues. According to Etienne Wenger, "Communities of practice exist to bring together individuals with interest and expertise in a given topic to exchange ideas and collectively improve their knowledge and understanding of it."

For the Uterotonics CoP, our goal is to encourage broader descriptive data collection on policy, supply, access, motivation for and use of uterotonic drugs by providing researchers and program managers examples of such work. We anticipate that this webspace will prevent researchers from reinventing the wheel with each new study, that it will promote and refine development of new tools, and contribute to greater coordination and collaboration among researchers working on this topic.

Here you will find several resources that we hope you will find useful. You will see below a link to our Library section devoted to uterotonic publications; an E-Learning module; and a list of some Tools (questionnaires) that have been submitted by colleagues. You will also find a reference list of publications housed on other sites.

Please note that this page is still a work-in-progress. As a part of this new 'community of practice', we encourage you to help make this a robust site. Please submit any resources that you believe would be a beneficial addition to this page to: This e-mail address is being protected from spambots. You need JavaScript enabled to view it . Thank you!

Library

Click here to view documents and papers related to uterotonics that are stored in our library

E-Learning

Active Management of the Third Stage of Labor: A Demonstration

Tools

India Follow Up Form - General / - Family Member
India Labor and Delivery Form - Maternal / - Fetal, Neonatal

This series of 4 untested questionnaires were developed for a study assessing the use of oxytocin on postpartum hemorrhage in India. Two of the questionnaires (Labor and Delivery; maternal and fetal/neonatal) are designed for use during labor and delivery at a peripheral health facility. The Follow up form is a questionnaire designed for a face-to-face interview with the recently delivered woman approximately one week following delivery (The Follow up family member questionnaire is the same, only for the rare event of a maternal death). The purpose of facility-based data collection during labor and delivery PLUS an interview with the recently delivered woman was to see if women can correctly report on the timing of the administration of uterotonic drugs at/around birth. As mentioned, these questionnaires have not been pre-tested. We include these here just for your review and as an example of one approach that was developed to better understand use of uterotonics at/around birth.

From Dr. Kirti Iyengar and colleagues
Questionnaire for recently delivered women (Related Study)

This is a quantitative survey tool for enquiring about childbirth practices from women who delivered in the last 3 months

Guide for observation of delivery (Related Study)

This is a qualitative tool for observing deliveries in different settings

From Dr. Allisyn Moran and colleagues
Quantitative questionnaire

For recently delivered women (within 6 months of survey) with a home birth or trial of labor at home. In English - Bangla version is also available.

Quantitative questionnaire

For village doctors to follow-up on reported oxytocin use as reported by women. In English - Bangla version is also available.

Qualitative in-depth interview

For recently delivered women (within 3 months of interview), village doctors, and traditional birth attendants (all three interviews in one document). In English and Bangla.

(Related Study)
(Related Study)

Quality of Medicines

Concern regarding the quality of medicines available to the population in low income countries is front and center in discussions about HIV, malaria and other infectious diseases. A quick search of the literature generates a long list of papers pertaining to counterfeit, sub-standard and degraded anti-malarials, antibiotics and ARVs. Indeed, many programs addressing these diseases require on-going surveillance of the quality of medicines for prevention and treatment of these diseases.

Attention to drug quality is only beginning to emerge as an issue of policy and programmatic concern for the maternal and newborn health community. For example, the USAID-funded Promoting Quality of Medicines (PQM) Program implemented by the United States Pharmacopeia has conducted studies of the quality of a list of emergency maternal and newborn medicines in Peru and Guatemala. In Indonesia, PQM and PATH have assessed the quality of oxytocin and the Oxytocin Initiative at PATH has assessed the quality of oxytocin and ergometrine in Ghana and India. Results from these countries vary, but most suggest a clear need for increased surveillance of these life-saving medicines and for increased awareness of the issues surrounding distribution and storage of medicines for the community in general. Another example is the work on maternal health commodities carried out by the USAID-funded Strengthening Pharmaceutical Systems (SPS) program, implemented by Management Sciences for Health. In several African countries, SPS has worked with national stakeholders to identify weaknesses in the pharmaceutical management of these essential commodities and develop plans to address them. Some of the most common problems contributing to lack of available of quality supplies are inaccurate forecasting of needs, broken distribution systems and poor storage conditions. A number of resources are available for further information. For example, on the USP website, one can find a Medicines Quality Database that compiles information on medicines quality testing in by country as well as a compilation of media reports on medicines quality. The website for SPS/MSH provides information on each component of the pharmaceutical management cycle and other useful information on pharmaceutical management in general.

Selected Articles

This list will soon be available to download as a PDF.

Blum J, Winikoff B, Raghavan S, Dabash R, Ramadan MC, Dilbaz B, Dao B, Durocher J, Yalvac S, Diop A, Dzuba IG, Ngoc NT. Treatment of post-partum haemorrhage with sublingual misoprostol versus oxytocin in women receiving prophylactic oxytocin: a double-blind, randomised, non-inferiority trial. Lancet. 2010 Jan 16;375(9710):217-23
This trial reported that sublingual misoprostol is non-inferior to intravenous oxytocin for treatment of postpartum haemorrhage in women receiving prophylactic oxytocin.

Hofmeyr GJ, Matonhodze BB, Alfirevic Z, Campbell E, de Jager M, Nikodem C. Titrated oral misoprostol solution--a new method of labour induction. S Afr Med J. 2001 Sep;91(9):775-6. (Full text available)
This study was conducted to develop a new method of misoprostol use for labour induction using very small, frequent, titrated oral dosages, and to pilot effectiveness.

Hofmeyr GJ, Alfirevic Z, Matonhodze B, Brocklehurst P, Campbell E, Nikodem VC. Titrated oral misoprostol solution for induction of labour: a multi-centre, randomised trial. BJOG. 2001 Sep;108(9):952-9. (Full text available)
This open randomized control trial was conducted to determine the effects of titrated oral misoprostol solution compared with vaginal dinoprostone and concluded that the administration of the oral misoprostol solution was successful in minimizing the risk of uterine hyperstimulation.

Hofmeyr GJ, Gülmezoglu AM, Novikova N, Linder V, Ferreira S, Piaggio G. Misoprostol to prevent and treat postpartum haemorrhage: a systematic review and meta-analysis of maternal deaths and dose-related effects. Bull World Health Organ. 2009 Sep;87(9):666-77. (Full text available)
This study reviewed maternal deaths and the dose-related effects of misoprostol on blood loss and pyrexia in randomized trials of misoprostol use for the prevention or treatment of postpartum haemorrhage and concluded that further research is needed to more accurately assess the potential beneficial and harmful effects of misoprostol and to determine the smallest dose that is effective and safe. In this review, 400 µg of misoprostol were found to be safer than 600 µg and just as effective.

Hofmeyr GJ, Gülmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev. 2010 Oct 6;(10):CD000941.
This is a systematic review to determine the effects of vaginal misoprostol for third trimester cervical ripening or induction of labour.

Hofmeyr GJ, Fawole B, Mugerwa K, Godi NP, Blignaut Q, Mangesi L, Singata M, Brady L, Blum J. Administration of 400 µg of misoprostol to augment routine active management of the third stage of labor. Int J Gynaecol Obstet. 2011 Feb;112(2):98-102.
The study assesses the effectiveness and safety of the administration of misoprostol, an orally active prostaglandin, in addition to routine uterotonic therapy as part of the active management of the third stage of labor.

Iyengar SD, Iyengar K, Martines JC, Dashora K, Deora KK. Childbirth practices in rural Rajasthan, India: implications for neonatal health and survival. J Perinatol. 2008 Dec;28 Suppl 2:S23-30.
This paper reports on the key findings from eight direct observations of labor and childbirth at home and in primary health facilities, as well as 10 focus group discussions, 18 case interviews with recently delivered women and 39 key informant interviews carried out within the community.

Iyengar SD, Iyengar K, Suhalka V, Agarwal K. Comparison of domiciliary and institutional delivery-care practices in rural Rajasthan, India. J Health Popul Nutr. 2009 Apr;27(2):303-12. (Full text available)
This study used a retrospective cross-sectional survey to assess key practices and costs relating to home- and institutional delivery care in rural Rajasthan, India. The authors concluded that widespread irrational practices by a range of care providers in both homes and facilities can adversely affect women and newborns while inadequate observance of beneficial practices and high costs are likely to reduce the benefits of institutional delivery, especially for the poor.

Kundodyiwa TW, Alfirevic Z, Weeks AD. Low-dose oral misoprostol for induction of labor: a systematic review. Obstet Gynecol. 2009 Feb;113(2 Pt 1):374-83.
This study estimates the efficacy and safety of low-dose oral misoprostol compared with dinoprostone (PGE2), vaginal misoprostol, and oxytocin for labor induction in women with a viable fetus.

Moran AC, Wahed T, Afsana K. Oxytocin to augment labour during home births: an exploratory study in the urban slums of Dhaka, Bangladesh. BJOG. 2010 Dec;117(13):1608-15.

Newton PN, Lee SJ, Goodman C, Fernández FM, Yeung S, Phanouvong S, Kaur H, Amin AA, Whitty CJ, Kokwaro GO, Lindegårdh N, Lukulay P, White LJ, Day NP, Green MD, White NJ. Guidelines for field surveys of the quality of medicines: a proposal. PLoS Med. 2009 Mar 24;6(3):e52. (Full text available)
This paper has discusses how medicine quality surveys can be conducted and how simple and efficient but statistically valid sampling techniques can be used to provide an estimate of the prevalence of outlets selling low-quality medicines.

Patted SS, Goudar SS, Naik VA, Bellad MB, Edlavitch SA, Kodkany BS, Patel A, Chakraborty H, Derman RJ, Geller SE. Side effects of oral misoprostol for the prevention of postpartum hemorrhage: results of a community-based randomised controlled trial in rural India. J Matern Fetal Neonatal Med. 2009 Jan;22(1):24-8.
This study investigates the side effects of 600 mcg oral misoprostol given for the mother and the newborn to prevent postpartum hemorrhage (PPH).

Sanghvi H, Ansari N, Prata NJ, Gibson H, Ehsan AT, Smith JM. Prevention of postpartum hemorrhage at home birth in Afghanistan. Int J Gynaecol Obstet. 2010 Mar;108(3):276-81.
This study tests the safety, acceptability, feasibility, and effectiveness of community-based education and distribution of misoprostol for prevention of postpartum hemorrhage at home birth in Afghanistan.

Sosa CG, Althabe F, Belizan JM, Buekens P. Use of oxytocin during early stages of labor and its effect on active management of third stage of labor. Am J Obstet Gynecol. 2011 Mar;204(3):238.e1-5.
The purpose of this study was to evaluate whether the use of oxytocin during the first and second stages of labor is associated with a higher incidence of postpartum hemorrhage (PPH) in pregnant women who received active management of third stage of labor (AMTSL).

Sutherland T, Meyer C, Bishai DM, Geller S, Miller S. Community-based distribution of misoprostol for treatment or prevention of postpartum hemorrhage: cost-effectiveness, mortality, and morbidity reduction analysis. Int J Gynaecol Obstet. 2010 Mar;108(3):289-94.
This study compares the cost-effectiveness of community-based distribution of misoprostol for prevention with misoprostol for treatment of postpartum hemorrhage (PPH).

Wahed T, Moran AC, Iqbal M. The perspectives of clients and unqualified allopathic practitioners on the management of delivery care in urban slums, Dhaka, Bangladesh - a mixed method study. BMC Pregnancy Childbirth. 2010 Sep 7;10:50.

Widmer M, Blum J, Hofmeyr GJ, Carroli G, Abdel-Aleem H, Lumbiganon P, Nguyen TN, Wojdyla D, Thinkhamrop J, Singata M, Mignini LE, Abdel-Aleem MA, Tran ST, Winikoff B. Misoprostol as an adjunct to standard uterotonics for treatment of post-partum haemorrhage: a multicentre, double-blind randomised trial. Lancet. 2010 May 22;375(9728):1808-13.
This study aims to assess the effectiveness of misoprostol as an adjunct to standard uterotonics compared with standard uterotonics alone for treatment of postpartum haemorrhage.

Winikoff B, Dabash R, Durocher J, Darwish E, Nguyen TN, León W, Raghavan S, Medhat I, Huynh TK, Barrera G, Blum J. Treatment of post-partum haemorrhage with sublingual misoprostol versus oxytocin in women not exposed to oxytocin during labour: a double-blind, randomised, non-inferiority trial. Lancet. 2010 Jan 16;375(9710):210-6.
This trial reported that sublingual misoprostol was similarly efficacious to intravenous oxytocin for treatment of post-partum haemorrhage in women not exposed to oxytocin during labour.