TITLE:
Uterotonic drugs use for post partum hemorrhage: An audit of the third stage of labor management
AUTHORS:
Etedafe P. Gharoro, Ehigha J. Enabudoso, Edafe E. Gharoro, Abieyuwa P. Osemwenkha
KEYWORDS:
Post Partum Hemorrhage; Uterotonic Drugs; Visual Estimation of Blood Loss; Shock Index; Active Management of Third Stage of Labor
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.3 No.3,
May
8,
2013
ABSTRACT:
Objectives: Worldwide the use of uterotonic drugs has significantly
reduced maternal mortality from postpartum hemorrhage. The objective is to
audit the use of uterotonics in the active management of the third and fourth
stages of labor. Methods: Personal
data, diagnostic clinical information, blood loss and uterotonics
administered were extracted from a cohort of 634 consecutive parturient. Trend
in Shock Index (Pulse Rate/Systolic Blood Pressure) and 48 hours hematocrit
changes were computed and analyzed. Results: There
were 422 vagina deliveries and 212 caesarean sections. Primiparous mothers were
141 (34.2%), while grand multiparous mothers were 14 (3.4%). The mean visually
estimated postpartum blood loss 165.9 ± 80 ml. There was no significant
difference in the mean blood loss between the three parity groups of parturient
[P = 0.09]. Fourteen parturient (3.44%) had blood loss ≥500 ml. The value of
Shock Index (Pulse Rate/Systolic Blood Pressure) in the study ranged between
0.43 and 1.38. Logistic regression analysis of the variables associated with
the switch between the three regimens of uterotonic drugs, showed a significant
positive correlation between VEBL and uterotonic drugs administered [Pearson
correlation = 0.130, P-value = 0.008]. In addition, there was a significant
negative correlation between uterotonic drugs administered and Shock Index
at 30 minutes and 2 hours postpartum. The correlation coefficient between
VEBL and regimens of uterotonic drugs used was positive and significant (P = 0.019). Conclusion: Visually estimated blood loss, with shock are the
main Triggers involved in switching between uterotonic drugs regimens used in
active management of PPH. Shock index calculation is vital in management
decision. We advocate training of all birth attendants on VEBL.