Drug utilization study of drugs used in the management of post-partum hemorrhage at a tertiary care hospital
Keywords:Postpartum haemorrhage, Oxytocin, Maternal mortality, Restricted manufacture
Background: Postpartum haemorrhage remains a major cause of both maternal mortality and morbidity worldwide, uterotonic drugs such as oxytocin, with or without ergometrine, have been used to prevent PPH. The objective to study the drugs used in the management of post-partum haemorrhage at a tertiary care hospital.
Methods: An observational and cross-sectional study design was adopted for this study. The case sheets of 100 patients presenting in active stage of labour to the labour room in a tertiary care hospital were analysed.
Results: In the prescriptions analysed from the patients in the labour room, drugs used to prevent PPH are oxytocin and misoprostol. Oxytocin is the most commonly prescribed drug to prevent PPH in the study group. It is a life-saving drug to prevent PPH and thereby maternal mortality. In the study group having 103 patients, a total of 81 patients received only 10 IU oxytocin IM and 14 patients received 10 IU oxytocin IM and 600 g misoprostol to prevent PPH.
Conclusions: Oxytocin is an essential drug included in the WHO essential drug list and in the national list of essential medicine, so it shouldn’t have been dealt in such a biased manner.
Vimala N, Mittal S, Kumar S. Sublingual misoprostol versus oxytocin infusion to reduce blood loss at cesarean section. Int J Gynaecol Obstet. 2006;92:106.
Pritchard JA, Baldwin RM, Dickey JC. Blood volume change in pregnancy and the puerperium; red blood cell loss and changes in apparent blood volume during and following vaginal delivery, cesarean section and cesarean section plus total hysterectomy. Am J Obstet Gynecol. 1962;84:1272-82.
Lynn P, Freedman RJ, Waldman HP, Wirth ME. Who’s got the power? Transforming health systems for women and children. UN Millenium Project Task Force Child Health Maternal Health. 2005:77-95.
Clark SL, Yeh SY, Phelan JP, Bruce S, Paul RH. Emergency hysterectomy for obstetric hemorrhage. Obstet Gynecol. 1984;64:376-80.
Combs CA, Murphy EL, Laros RK. Factors associated with postpartum hemorrhage with vaginal birth. Obstet Gynecol. 1991;77:69-76.
Ramanathan G, Arulkumaran S. Post-partum haemorrhage. Curr Obstet Gynaecol. 2006;16(1):6-13.
Kane TT, Kady EAA, Saleh S, Hage M, Stanback J, Potter L. Maternal mortality in Giza, Egypt: magnitude, causes, and prevention. Stud Fam Plann. 1992;23:45-57.
Shrestha A, Dongol A, Chawla CD, Adhikari RK. Rectal Misoprostol versus Intramuscular Oxytocin for Prevention of Post-Partum Hemorrhage. Kathmandu Univ Med J. 2011;9(33):1.
Rogers J, Wood J, McCandlish R, Ayers S, Truesdale A, Elbourne D. Active versus expectant management of third stage of labour: The Hinchingbrooke randomised controlled trial. Lancet. 1998;351:693-9.
Khan GQ, John IS, Wani S, Doherty T, Sibai BM. Controlled cord traction versus minimal intervention techniques in delivery of the placenta: A randomized controlled trial. Am J Obstet Gynecol. 1997;177:770-4.
Nordstrom L, Fogelstam K, Fridman G, Larsson A, Rydhstroem H. Routine oxytocin in the third stage of labour: A placebo controlled randomized trial. Br J Obstet Gynaecol. 1997;104:781-6.
Refaey EH, Noor R, Brien OP, Abdellah M, Geary M, Walder J, et al. The misoprostol for third stage of labour study. Br J Obstet Gynecol. 2000;107:1104-10.
Walt RP. Misoprostol for the treatment of peptic ulcer and anti-inflammatory drug induced gastroduodenal ulceration. N Engl J Med. 1992;327:1575-80.
Zieman M, Fong SK, Benowitz NL, Bankster D, Darney PD. Absorption kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol. 1997;90:88-92.
Surbek DV, Boesiger H, Hoesli I, Pavic N, Holzgreve W. A double-blind comparison of the safety and efficacy of intravaginal misoprostol and prostaglandin E2 to induce labour. Am J Obstet Gynecol. 1997;177:1018-23.
World Health Organization. WHO recommendations for the prevention and treatment of postpartum hemorrhage. Geneva: WHO; 2012. Available at https://apps.who.int/iris/bitstream/handle/10665/75411/9789241548502_eng.pdf;sequence=1. Accessed on 15 March 2019.
Maternal Health Division, Union Ministry of Health and Family Welfare. Guidance note on use of uterotonics during labour; 2015. Available at http://nhm.gov.in/images/pdf/programmes/maternalhealth/guidelines/Guidance_Notes_on_Use_of_Uterotonics_during_labor.pdf. Accessed on 12 March 2019.
Government of India, Ministry of Health and Family Welfare, Department of Health and Family Welfare (Drugs Regulation Section) Nirman Bhawan, New Delhi Dated the 1 August 2018.
Pullakhandam R, Palika R, Vemula SR, Polasa K, Boindala S. Effect of Oxytocin injection to milching buffaloes on its content and stability in milk. Indian J Med Res. 2014;139(6):933-9.
The Hindu 18 August 2018 21:10 Ist. 2018.