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close this book10. Over-medicalisation of Maternal Care in Developing Countries
View the document(introduction...)
View the documentSummary
View the documentIntroduction
View the documentCaesarean Sections
View the documentEpisiotomies
View the documentOxytocics
View the documentStrategies to Decrease the Use of Unnecessary Interventions
View the documentDiscussion and Conclusions
View the documentReferences

Oxytocics

The use of oxytocics is part of the package of basic emergency obstetrical care recommended by international agencies (Donnay 2000). There is very strong evidence in favor of injecting oxytocics routinely during the third stage of labor. A systematic review of four trials that compared active management (including injection of oxytocics) of third stage to expectant management showed that routine active management is superior to expectant management in terms of blood loss, post-partum haemorrhage (RR 0.35 95% CI 0.28-0.42), severe post-partum haemorrhage (RR 0.37 95% CI 0.23-0.61), the need of blood transfusion during the puerperium (RR 0.34 95% CI 0.22-0.54)and postpartum anaemia (RR 0.40 95% CI 0.29-0.55) (Prendiville et al. 2000).

Table 2. Use of oxytocics in developing countries

Country (city)

Year

Reference

Oxytocin during 1st and/or 2nd stage of labor (%)

Oxytocics during 3rd stage of labor or postpartum (%)

Jamaica (Parish A)

1986-1987

(Escoffery et al. 1994)

14.9

90.4

Jamaica (Parish B1)

1986-1987

(Escoffery et al. 1994)

11.4

85.2

Jamaica (Parish B2)

1986-1987

(Escoffery et al. 1994)

10.8

82.5

Jamaica (Parish C)

1986-1987

(Escoffery et al. 1994)

5.6

80.7

Benin (Abomey)

1990-1991

(Dujardin et al. 1995)

16.1

NA

Benin (Porto Novo)

1990-1991

(Dujardin et al. 1995)

24.2

NA

Congo (Loubomo)

1990-1991

(Dujardin et al. 1995)

5.7

NA

Senegal (Pikine)

1990-1991

(Dujardin et al. 1995)

10.9

NA

Ivory Coast (Abidjan)

1994-1996

(Bouvier-Colle et al. 1998)

13.4

35.7

Mali (Bamako)

1994-1996

(Bouvier-Colle et al. 1998)

26.1

5.7

Niger (Niamey)

1994-1996

(Bouvier-Colle et al. 1998)

5.7

12.5

Mauritania (Nouakchott)

1994-1996

(Bouvier-Colle et al. 1998)

13.0

29.3

Burkina Faso (Ouagadougou)

1994-1996

(Bouvier-Colle et al. 1998)

10.5

23.3

Senegal (St Louis)

1994-1996

(Bouvier-Colle et al. 1998)

32.9

63.1

Senegal (Kaolack)

1994-1996

(Bouvier-Colle et al. 1998)

2.5

48.1

Nepal (Kathmandu)

1995-1996

(Ellis et al. , 2000)

31.1

NA

NA denotes data not available.

How frequently oxytocin needs to be used during the first and second stages of labor is a far more controversial issue. Oxytocin is used both to induce and to augment labor. The administration of excessive doses of oxytocin may cause hyper-stimulation and even uterine contracture (Dujardin et al. 1995). The risk is probably higher in developing counties where the drug is often administered by intra-muscular injection, or without a pump controlling the speed of intravenous infusion. Studies from West Africa and Nepal suggest an increased risk of foetal distress and neonatal morbidity associated with the use of oxytocin during labor (Dujardin et al. 1995, Ellis et al. 2000).

Data on the use of oxytocics are very limited. However, Table 2 shows large variations of frequencies of use of oxytocin during first and second stage of labor. Interestingly enough, the two extreme values of the distribution were observed in Senegal, with a frequency of 2.5% in Kaolack and of 32.9% in St Louis. The table also shows that active management of the third stage of labor was far more common in Jamaica than in West Africa.