PATH, New Delhi, India.
PLoS One. 2013 Apr 29;8(4):e62801. doi: 10.1371/journal.pone.0062801. Print 2013.
India has the highest annual number of maternal deaths of any country. As obstetric hemorrhage is the leading cause of maternal death in India, numerous efforts are under way to promote access to skilled attendance at birth and emergency obstetric care. Current initiatives also seek to increase access to active management of the third stage of labor for postpartum hemorrhage prevention, particularly through administration of an uterotonic after delivery. However, prior research suggests widespread inappropriate use of uterotonics at facilities and in communities-for example, without adequate monitoring or referral support for complications. This qualitative study aimed to document health providers' and community members' current knowledge, attitudes, and practices regarding uterotonic use during labor and delivery in India's Karnataka state.
140 in-depth interviews were conducted from June to August 2011 in Bagalkot and Hassan districts with physicians, nurses, recently delivered women, mothers-in-law, traditional birth attendants (dais), unlicensed village doctors, and chemists (pharmacists).
Many respondents reported use of uterotonics, particularly oxytocin, for labor augmentation in both facility-based and home-based deliveries. The study also identified contextual factors that promote inappropriate uterotonic use, including high value placed on pain during labor; perceived pressure to provide or receive uterotonics early in labor and delivery, perhaps leading to administration of uterotonics despite awareness of risks; and lack of consistent and correct knowledge regarding safe storage, dosing, and administration of oxytocin.
These findings have significant implications for public health programs in a context of widespread and potentially increasing availability of uterotonics. Among other responses, efforts are needed to improve communication between community members and providers regarding uterotonic use during labor and delivery and to target training and other interventions to address identified gaps in knowledge and ensure that providers and pharmacists have up-to-date information regarding proper usage of uterotonic drugs.
印度是全世界孕产妇死亡人数最多的国家。在印度，产科出血是导致孕产妇死亡的首要原因，因此正在采取多项措施以增加获得熟练接生和紧急产科护理的机会。目前的举措还旨在增加获得产后出血预防性使用子宫收缩剂的机会，特别是在分娩后使用宫缩剂。然而，先前的研究表明，在医疗机构和社区中广泛存在子宫收缩剂使用不当的情况，例如，没有充分的监测或并发症转诊支持。这项定性研究旨在记录印度卡纳塔克邦的卫生保健提供者和社区成员在分娩期间使用子宫收缩剂的现有知识、态度和实践。
2011 年 6 月至 8 月，在巴加尔果特和哈桑地区对医生、护士、刚分娩的妇女、婆婆、传统助产士（daise）、无牌乡村医生和药剂师（药剂师）进行了 140 次深入访谈。
许多受访者报告说，无论是在医疗机构还是家庭分娩中，都使用子宫收缩剂，特别是催产素来促进分娩。研究还确定了促进不适当使用子宫收缩剂的背景因素，包括对分娩期间疼痛的高度重视；在分娩和分娩早期提供或接受子宫收缩剂的压力感知，这可能导致尽管意识到风险仍使用子宫收缩剂；以及缺乏关于催产素安全储存、剂量和管理的一致和正确知识。
这些发现对广泛存在且可能增加子宫收缩剂供应的情况下的公共卫生计划具有重要意义。除其他措施外，还需要努力改善社区成员与提供者之间关于分娩期间使用子宫收缩剂的沟通，并针对培训和其他干预措施，以解决知识差距问题，并确保提供者和药剂师掌握有关正确使用子宫收缩药物的最新信息。
