Uterotonics Community of Practice

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.

Background. Misoprostol, a cheap, stable, orally active prostaglandin analogue, is effective for labour induction when administered either vaginally or orally, but uterine hyperstimulation and rupture have been reported. Previous studies of oral misoprostol for labour induction have used fixed dosages 3-6-hourly. Objectives. To develop a new method of misoprostol use for labour induction using very small, frequent, titrated oral dosages, and to pilot effectiveness. Study design. Open clinical pilot study. Setting. Coronation Hospital, an academic hospital in Johannesburg, South Africa. Methods. We developed a method using 2-hourly titrated misoprostol doses commencing with 20 pg, increased after three doses to 40 pg. To administer such small doses we dissolved one misoprostol tablet in 200 ml water. A pilot study of this method was undertaken in 25 women with various indications for induction of labour. Results. Eighteen women (72%) delivered vaginally within 32 hours of induction and two women developed uterine hyperstimulation. The caesarean section rate was 20%. Conclusions. Women may respond to much smaller dosages of misoprostol than are currently in use. A multicentre randomised trial of this method is underway. We emphasise the dangers inherent in the current unregistered use of misoprostol in clinical practice

Quantitative questionnaire for village doctors to follow-up on reported oxytocin use as reported by women (in English - Bangla version is also available)

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)

This is a quantitative survey tool for enquiring about childbirth practices from women who delivered in the last 3 months from Dr. Kirti Iyengar and colleagues

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)

Objective: To review 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. Methods: We searched the Cochrane Controlled Trials Register and Pubmed, without language restrictions, for “(misoprostol AND postpartum) OR (misoprostol AND haemorrhage) OR (misoprostol AND hemorrhage)”, and we evaluated reports identi?ed through the Cochrane Pregnancy and Childbirth Group search strategy. Randomized trials comparing misoprostol with either placebo or another uterotonic to prevent or treat postpartum haemorrhage were checked for eligibility. Data were extracted, tabulated and analysed with Reviewer Manager (RevMan) 4.3 software. Findings: We included 46 trials with more than 40 000 participants in the ?nal analysis. Of 11 deaths reported in 5 trials, 8 occurred in women receiving * 600 µg of misoprostol (Peto odds ratio, OR: 2.49; 95% con?dence interval, CI: 0.76–8.13). Severe morbidity, de?ned as the need for major surgery, admission to intensive care, organ failure or body temperature  * 40 °C, was relatively infrequent. In prevention trials, severe morbidity was experienced by 16 of 10 281 women on misoprostol and by 16 of 10 292 women on conventional uterotonics; in treatment trials, it was experienced by 1 of 32 women on misoprostol and by 1 of 32 women on conventional uterotonics. Misoprostol recipients experienced more adverse events than placebo recipients: 8 of 2070 versus 5 of 2032, respectively, in prevention trials, and 5 of 196 versus 2 of 202, respectively, in treatment trials. Meta-analysis of direct and adjusted indirect comparisons of the results of randomized trials showed no evidence that 600 µg are more effective than 400 µg for preventing blood loss * 1000 ml (relative risk, RR: 1.02; 95% CI: 0.71–1.48). Pyrexia was more than twice as common among women who received *600 µg rather than 400 µg of misoprostol (RR: 2.53; 95% CI: 1.78–3.60). Conclusion: Further research is needed to more accurately assess the potential bene?cial 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.

This is part of a series of 4 untested questionnaires that 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.

This is part of a series of 4 untested questionnaires that 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.

This is part of a series of 4 untested questionnaires that 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.

This is part of a series of 4 untested questionnaires that 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.

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.

This is a qualitative tool for observing deliveries in different settings from Dr. Kirti Iyengar and colleagues.

This review provides an overview of uterine muscle physiology, describe currently available biological screening procedures for testing of uterotonic plant compounds and summarize traditionally used uterotonic plants, their active components and their mechanisms.

To determine feasibility of community-based distribution of misoprostol for preventing postpartumhemorrhage (PPH) to pregnant woman through community volunteers working under government healthservices. Methods: Implemented in one district in Nepal. The primary measure of performance was uterotonicprotection after childbirth, measured using pre- and postintervention surveys (28 clusters, each with 30households). Maternal deaths were ascertained through systematic health facility and community-basedsurveillance; causes of death were assigned based on verbal autopsy. Results: Of 840 postintervention survey respondents, 73.2% received misoprostol. The standardized proportion of vaginal deliveries protected by auterotonic rose from 11.6% to 74.2%. Those experiencing the largest gains were the poor, the illiterate, andthose living in remote areas. Conclusion: Community-based distribution of misoprostol for PPH prevention canbe successfully implemented under government health services in a low-resource, geographically challengingsetting, resulting in much increased population-level protection against PPH, with particularly large gainsamong the disadvantaged.

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.