ICMR - National Institute of Cancer Prevention and Research (NICPR), I-7, Sector -39, Noida, Uttar Pradesh 201301, India; Division of Reproductive Biology, Maternal & Child Health, Indian Council of Medical Research (ICMR), New Delhi 110029, India.
Division of Reproductive Biology, Maternal & Child Health, Indian Council of Medical Research (ICMR), New Delhi 110029, India.
Sex Reprod Healthc. 2021 Sep;29:100624. doi: 10.1016/j.srhc.2021.100624. Epub 2021 Apr 23.
The main objective is to understand the practices regarding use of uterotonics during active labour and for prevention of postpartum haemorrhage and the barriers for its optimal and appropriate use at different levels of health facilities in five states of India.
Mixed methods approach comprising of cross-sectional observational study of existing practices of uterotonics use during labour and early postpartum period for 1479 vaginal deliveries at 56 facilities. Quantitative data was collected using pre-tested proformas filled by on-site observers and qualitative data was collected by in-depth interviews of 125 maternity care providers of the observed facilities.
Providers' knowledge, attitude and patterns of use of uterotonics during active labour and for prevention of postpartum haemorrhage during childbirth.
On-site observation and interviews indicated inappropriate choice of uterotonics administered in varied doses for labour management across facilities. Unnecessary augmentation of labour was observed in 44.7% low-risk pregnancies and only 31% women were administered uterotonics in optimal doses for preventing postpartum haemorrhage. Only 46.4% providers in the observed facilities reported to have received maternal and child healthcare training according to the updated guidelines. Lack of supportive supervision for mandated practices among peers emerged as an important barrier for appropriate uterotonics usage in labour.
There is an urgent scope of standardizing the institutional health policies regarding administration of uterotonics during labour and for prevention of postpartum haemorrhage. Capacity building of maternity care providers regarding appropriate uterotonics usage is recommended for all levels of health facilities.
本研究旨在了解印度五个邦不同级别医疗机构在产程中使用宫缩剂预防产后出血的实践情况，以及影响宫缩剂合理使用的障碍因素。
本研究采用混合方法，包括对 56 家医疗机构 1479 例阴道分娩产妇产程中和产后早期宫缩剂使用情况的横断面观察性研究。通过现场观察者填写的预测试表单收集定量数据，通过对观察到的医疗机构的 125 名产科医务人员进行深入访谈收集定性数据。
医务人员在产程中及分娩时预防产后出血使用宫缩剂的知识、态度和使用模式。
现场观察和访谈表明，不同医疗机构在产程中使用宫缩剂的剂量和种类存在不规范。在低危妊娠中，44.7%的产妇不必要地接受了宫缩剂的增强宫缩处理，只有 31%的产妇接受了最佳剂量的宫缩剂来预防产后出血。在所观察的医疗机构中，仅有 46.4%的医务人员报告按照最新指南接受过母婴保健培训。缺乏对同行强制性实践的支持性监督，是宫缩剂在产程中合理使用的一个重要障碍。
有必要规范医疗机构在产程中使用宫缩剂和预防产后出血的政策。建议为各级医疗机构的医务人员提供关于宫缩剂合理使用的能力建设。
