1
|
Burgod C, Pant S, Morales MM, Montaldo P, Ivain P, Elangovan R, Bassett P, Thayyil S. Effect of intra-partum Oxytocin on neonatal encephalopathy: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2021; 21:736. [PMID: 34717571 PMCID: PMC8556930 DOI: 10.1186/s12884-021-04216-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/15/2021] [Indexed: 11/15/2022] Open
Abstract
Background Oxytocin is widely used for induction and augmentation of labour, particularly in low- and middle-income countries (LMICs). In this systematic review and meta-analysis, we examined the effect of intra-partum Oxytocin use on neonatal encephalopathy. Methods The protocol for this study was registered with PROSPERO (ID: CRD42020165049). We searched Medline, Embase and Web of Science Core Collection databases for papers published between January 1970 and May 2021. We considered all studies involving term and near-term (≥36 weeks’ gestation) primigravidae and multiparous women. We included all randomised, quasi-randomised clinical trials, retrospective studies and non-randomised prospective studies reporting intra-partum Oxytocin administration for induction and/or augmentation of labour. Our primary outcome was neonatal encephalopathy. Risk of bias was assessed in non-randomised studies using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. The RoB 2.0 tool was used for randomised studies. A Mantel-Haenszel statistical method and random effects analysis model were used for meta-analysis. Odds ratios were used to determine effect measure and reported with 95% confidence intervals. Results We included data from seven studies (6 Case-control studies, 1 cluster-randomised trial) of which 3 took place in high-income countries (HICs) and 4 in LMICs. The pooled data included a total of 24,208 women giving birth at or after 36 weeks; 7642 had intra-partum Oxytocin for induction and/or augmentation of labour, and 16,566 did not receive intra-partum Oxytocin. Oxytocin use was associated with an increased prevalence of neonatal encephalopathy (Odds Ratio 2.19, 95% CI 1.58 to 3.04; p < 0.00001). Conclusions Intra-partum Oxytocin may increase the risk of neonatal encephalopathy. Future clinical trials of uterotonics should include neonatal encephalopathy as a key outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04216-3.
Collapse
Affiliation(s)
- Constance Burgod
- Centre for Perinatal Neuroscience, Imperial College London, Du Cane Road, London, W12 0HS, UK.
| | - Stuti Pant
- Centre for Perinatal Neuroscience, Imperial College London, Du Cane Road, London, W12 0HS, UK
| | - Maria Moreno Morales
- Centre for Perinatal Neuroscience, Imperial College London, Du Cane Road, London, W12 0HS, UK
| | - Paolo Montaldo
- Centre for Perinatal Neuroscience, Imperial College London, Du Cane Road, London, W12 0HS, UK.,Neonatal Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Phoebe Ivain
- Centre for Perinatal Neuroscience, Imperial College London, Du Cane Road, London, W12 0HS, UK
| | - Ramyia Elangovan
- Centre for Perinatal Neuroscience, Imperial College London, Du Cane Road, London, W12 0HS, UK
| | - Paul Bassett
- Statsconsultancy Ltd., Amersham, London, England
| | - Sudhin Thayyil
- Centre for Perinatal Neuroscience, Imperial College London, Du Cane Road, London, W12 0HS, UK
| |
Collapse
|
2
|
Hodgins S. New Evidence on Carbetocin: Another Arrow in Our Quiver. GLOBAL HEALTH: SCIENCE AND PRACTICE 2018; 6:405-407. [PMID: 30287526 PMCID: PMC6172116 DOI: 10.9745/ghsp-d-18-00336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Carbetocin is more heat stable than oxytocin with at least equivalent efficacy for preventing postpartum hemorrhage. It will certainly be helpful if the supplier can make it available in low-income country settings at a price comparable to oxytocin. But even so, programs will still need oxytocin and other uterotonic medications.
Collapse
Affiliation(s)
- Steve Hodgins
- Editor-in-Chief, Global Health: Science and Practice Journal, and Associate Professor, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
3
|
Kozuki N, Mullany LC, Khatry SK, Tielsch JM, LeClerq SC, Kennedy CE, Katz J. Perceptions, careseeking, and experiences pertaining to non-cephalic births in rural Sarlahi District, Nepal: a qualitative study. BMC Pregnancy Childbirth 2018; 18:89. [PMID: 29636021 PMCID: PMC5894138 DOI: 10.1186/s12884-018-1724-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/29/2018] [Indexed: 11/12/2022] Open
Abstract
Background In low-resource settings, a significant proportion of fetal, neonatal, and maternal deaths can be attributed to intrapartum-related complications. Certain risk factors, such as non-cephalic presentation, have a particularly high risk of complications. This qualitative study describes experiences around non-cephalic births and highlights existing perceptions and care-seeking behavior specific to non-cephalic presentation in rural Sarlahi District, Nepal. Methods We conducted in-depth interviews with 34 individuals, including women who recently gave birth to a non-cephalic infant and female decision-makers in their households. We also conducted two focus groups with mothers (have two or more children, with at least one child under age five) and two focus groups with grandmothers in the community. Results Several women described scenes of obstructed labor and practices like provision of unspecified injections early in labor to assist with the delivery. There were reports of arduous care-seeking processes from primary health centers to tertiary facilities, and mixed quality of care among home birth attendants and facility-based health workers respectively. Very few women were aware of the fetal presentation prior to delivery, and we identified no consistent understanding among participants of the risks of and care strategies for non-cephalic births. Risk perception around non-cephalic presentation varied widely. Some participants were acutely aware of potential dangers, while others had not heard of non-cephalic birth. Many interviewees said that the position in which a pregnant woman sleeps could impact the fetal position. Several participants had either taken or heard of medication intended to rotate the fetus into the correct position. Conclusions Our findings suggest the mixed quality of and access to care associated with non-cephalic birth and a lack of consistent understanding of the risk of and care for non-cephalic births in rural Nepal. The high risk of the condition and the recommended tertiary care present a dilemma in low-resource settings; the logistical difficulties and the mixed quality of care make care-seeking and referral decisions complex. While public health stakeholders strive to improve the quality of and access to the formal health system, those players must also be sensitive to the potential negative implications of promoting institutional care-seeking. Electronic supplementary material The online version of this article (10.1186/s12884-018-1724-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Naoko Kozuki
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - James M Tielsch
- Department of Global Health, George Washington University School of Public Health and Health Services, Washington, DC, USA
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| |
Collapse
|
4
|
Lama TP, Khatry SK, Katz J, LeClerq SC, Mullany LC. Illness recognition, decision-making, and care-seeking for maternal and newborn complications: a qualitative study in Sarlahi District, Nepal. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2017; 36:45. [PMID: 29297386 PMCID: PMC5764053 DOI: 10.1186/s41043-017-0123-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Identification of maternal and newborn illness and the decision-making and subsequent care-seeking patterns are poorly understood in Nepal. We aimed to characterize the process and factors influencing recognition of complications, the decision-making process, and care-seeking behavior among families and communities who experienced a maternal complication, death, neonatal illness, or death in a rural setting of Nepal. METHODS Thirty-two event narratives (six maternal/newborn deaths each and 10 maternal/newborn illnesses each) were collected using in-depth interviews and small group interviews. We purposively sampled across specific illness and complication definitions, using data collected prospectively from a cohort of women and newborns followed from pregnancy through the first 28 days postpartum. The event narratives were coded and analyzed for common themes corresponding to three main domains of illness recognition, decision-making, and care-seeking; detailed event timelines were created for each. RESULTS While signs were typically recognized early, delays in perceiving the severity of illness compromised prompt care-seeking in both maternal and newborn cases. Further, care was often sought initially from informal health providers such as traditional birth attendants, traditional healers, and village doctors. Key decision-makers were usually female family members; husbands played limited roles in decisions related to care-seeking, with broader family involvement in decision-making for newborns. Barriers to seeking care at any type of health facility included transport problems, lack of money, night-time illness events, low perceived severity, and distance to facility. Facility care was often sought only after referral or following treatment failure from an informal provider and private facilities were sought for newborn care. Respondents characterized government facility-based care as low quality and reported staff rudeness and drug type and/or supply stock shortages. CONCLUSION Delaying the decision to seek skilled care was common in both newborn and maternal cases. Among maternal cases, delays in receiving appropriate care when at a facility were also seen. Improved recognition of danger signs and increased demand for skilled care, motivated through community level interventions and health worker mobilization, needs to be encouraged. Engaging informal providers through training in improved danger sign identification and prompt referral, especially for newborn illnesses, is recommended.
Collapse
Affiliation(s)
- Tsering P. Lama
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, W5009, Baltimore, MD 21205 USA
| | - Subarna K. Khatry
- Nepal Nutrition Intervention Project—Sarlahi (NNIPS), Kathmandu, Nepal
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, W5009, Baltimore, MD 21205 USA
| | - Steven C. LeClerq
- Nepal Nutrition Intervention Project—Sarlahi (NNIPS), Kathmandu, Nepal
| | - Luke C. Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, W5009, Baltimore, MD 21205 USA
| |
Collapse
|
5
|
Day LT, Hruschka D, Mussell F, Jeffers E, Saha SL, Alam S. Perinatal mortality associated with use of uterotonics outside of Comprehensive Emergency Obstetric and Neonatal Care: a cross-sectional study. Reprod Health 2016; 13:129. [PMID: 27716260 PMCID: PMC5054615 DOI: 10.1186/s12978-016-0241-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/16/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Prior studies have shown that using uterotonics to augment or induce labor before arrival at comprehensive Emergency Obstetric and Neonatal Care (CEmONC) settings (henceforth, "outside uterotonics") may contribute to perinatal mortality in low- and middle-income countries. We estimate its effect on perinatal mortality in rural Bangladesh. METHODS Using hospital records (23986 singleton term births, Jan 1, 2009-Dec 31, 2015) from rural Bangladesh, we use a logistic regression model to estimate the increased risk of perinatal death from uterotonics administered outside a CEmONC facility. RESULTS Among term births (≥37 weeks gestation), the risk of perinatal death adjusted for key confounders is significantly increased among women reporting uterotonic use outside of CEmONC (OR = 3 · 0, 95 % CI = 2 · 4,3 · 7). This increased risk is particularly high for fresh stillbirths (OR = 4 · 0, 95 % CI = 3 · 0,5 · 3) and intrapartum-related causes of early neonatal deaths (birth asphyxia) (OR = 3 · 1, 95 % CI = 2 · 2,4 · 5). CONCLUSIONS In this sample, outside uterotonic use was associated with substantially increased risk of fresh stillbirths, deaths due to birth asphyxia, and all perinatal deaths. In settings of high uterotonic use outside of controlled settings, substantial improvement in both stillbirth and early neonatal mortality may be made by reducing such use.
Collapse
Affiliation(s)
- Louise T Day
- LAMB MIS-Research Department, Parbatipur, Dinajpur, 5250, Bangladesh.
- LAMB Hospital Pediatric Department, Parbatipur, Dinajpur, 5250, Bangladesh.
| | | | - Felicity Mussell
- LAMB Hospital Obstetric Department, Parbatipur, Dinajpur, 5250, Bangladesh
| | - Eva Jeffers
- Arizona State University, Tempe, AZ, 85287, USA
| | - Stacy L Saha
- LAMB MIS-Research Department, Parbatipur, Dinajpur, 5250, Bangladesh
| | - Shafiul Alam
- LAMB MIS-Research Department, Parbatipur, Dinajpur, 5250, Bangladesh
| |
Collapse
|