Barriers to optimal and appropriate use of uterotonics during active labour and for prevention of postpartum haemorrhage in public health care facilities: An exploratory study in five states of India

Singh, Shalini; Chandhiok, Nomita; Dubey, Ritam; Goel, Richa; Kashyap, Jyotika A

doi:10.1016/j.srhc.2021.100624

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…The study highlighted the need for comprehensive training, improved guideline awareness, regular supervision, and addressing traditional practices to enhance the quality of maternal and newborn healthcare in India. 23 In corroboration with the above-mentioned studies, the study conducted in Karnataka highlighted the need for standardized guidelines, enhanced training, and improved community education to ensure the safe and appropriate utilization of uterotonics during labour and delivery. The study examined uterotonic use during childbirth in two districts of Karnataka; Bagalkot and Hassan.…”

Section: Discussionmentioning

confidence: 73%

Assessing the Effect of Integrated Health Interventions on Maternal and Neonatal Health Outcomes in an aspirational district of Uttar Pradesh: A mixed method study

Yadav,

Ahmad,

Lohani

et al. 2024

Preprint

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Introduction: India has made significant progress in maternal and neonatal health, yet challenges persist. This study examines Shrawasti, a Uttar Pradesh district, to understand strategies for enhancing maternal and neonatal health. It particularly focuses on birth asphyxia and postpartum haemorrhage due to oxytocin misuse. Objective: To compare pre- and post-intervention maternal and newborn complications in Shrawasti and identify factors decreasing postpartum haemorrhage, newborn deaths, stillbirths, and birth asphyxia. The study aims to elucidate effective interventions for improving maternal and neonatal health. Methodology: A retrospective observational study collected data from labour rooms and the Special Newborn Care Unit in Shrawasti. In-depth interviews with healthcare workers provided qualitative insights. Interventions were implemented based on initial findings and evaluated through systematic data organization and assessment. Results: Post-intervention, there was a significant reduction in stillbirths, asphyxia, and postpartum haemorrhage. Asphyxia decreased from 74.5% to 33.2%, stillbirths from 28.5% to 12.5%, and postpartum haemorrhage from 53.8% to 26%. Qualitative analysis highlighted improved healthcare practices, training effectiveness, staff behaviour shifts, and enhanced patient awareness. Documentation and monitoring practices also improved significantly. Conclusion: Interventions significantly transformed maternal and neonatal healthcare in Shrawasti. Enhanced awareness, revised practices in oxytocin administration, effective training, and improved documentation were pivotal in reducing adverse outcomes. Addressing challenges through targeted interventions is crucial for better healthcare outcomes.

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Section: Discussionmentioning

confidence: 73%

Assessing the Effect of Integrated Health Interventions on Maternal and Neonatal Health Outcomes in an aspirational district of Uttar Pradesh: A mixed method study

Yadav,

Ahmad,

Lohani

et al. 2024

Preprint

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“…Though not as explicitly documented, this scenario may be indicative of the demonstrated larger problem and is likely true in other countries as well [17,47,50]. Research exploring this in other countries describes ineffective task sharing between doctors and midwives, and delays in family members authorizing providers to initiate emergency care measures.…”

Section: Discussionmentioning

confidence: 95%

Reducing maternal mortality through identifying unmet need for postpartum hemorrhage stabilization in rural emergency obstetric care facilities: Development and testing of a tool in Bangladesh

Mamun,

Shajahan,

Williams

et al. 2023

Preprint

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Background: Maternal mortality is stagnating globally, and postpartum hemorrhage (PPH) is the leading contributor. Time from onset of PPH to death is estimated at two hours, the fastest of all life-threatening obstetric complications. Resistance to treatment of critical obstetric emergencies in rural settings is ubiquitous and under-reported. Ensuring initial stabilization close to communities is central to improving maternal mortality rates. Systemic and unspoken refusal of care leads to hidden unmet need for treatment of PPH. Current global guidance for monitoring emergency obstetric care may be inadequate. Aim: The aim of this research was to develop a tool that measures unmet need for PPH stabilization in local health facilities. The newly developed tool was tested in rural sub-districts in Bangladesh. The results and their implications are discussed. Method: A proposed calculation was developed for determining the expected number of PPH cases in a given population based on its size, birth rates, community delivery rate, and estimates of PPH rates. Using the new tool, calculated estimates were applied to rural districts in Bangladesh against actual numbers of PPH cases managed in public district and sub-district hospitals. Births in private and NGO facilities were also accounted for. Findings: Substantial discrepancies were found between expected PPH arising in rural areas and PPH treated in rural facilities in those areas. The actual number of cases treated at local rural public facilities was 16% of what was expected. This is a notable finding that is missed by using global recommendations for monitoring EmONC signal functions. Conclusion: The proposed tool presents an opportunity for countries to examine the availability of facility response to obstetric emergencies, specifically PPH, in facilities reported to be providing basic emergency obstetric care. Establishing a simple method for the calculation of expected numbers of PPH will help countries to address hidden gaps. Further research is needed in other contexts to verify this tool and investigate if uncovering under performance of health facilities could be an opportunity for strengthening maternal and newborn health systems.

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“…However, evidence–practice gaps exist with even proven interventions. In a cross‐sectional observational study across 56 facilities in India, uterotonic administration after delivery was administered correctly to only 31% women 10 . Conversely, because of this evidence–practice gap, patients may get care that is either not needed or that could potentially be injurious, 11 exposing them to unwanted risks of iatrogenic harm.…”

Section: Cross‐sectoral Collaboration and Partnershipsmentioning

confidence: 99%

Connecting the dots: Adoption of maternal, newborn and child health research evidence in policy and practice

Chandhiok,

Goudar,

Kavi

et al. 2023

BJOG

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Barriers to optimal and appropriate use of uterotonics during active labour and for prevention of postpartum haemorrhage in public health care facilities: An exploratory study in five states of India

Cited by 5 publications

References 22 publications

Assessing the Effect of Integrated Health Interventions on Maternal and Neonatal Health Outcomes in an aspirational district of Uttar Pradesh: A mixed method study

Assessing the Effect of Integrated Health Interventions on Maternal and Neonatal Health Outcomes in an aspirational district of Uttar Pradesh: A mixed method study

Reducing maternal mortality through identifying unmet need for postpartum hemorrhage stabilization in rural emergency obstetric care facilities: Development and testing of a tool in Bangladesh

Connecting the dots: Adoption of maternal, newborn and child health research evidence in policy and practice

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