Abstract
Background:Post-partum hemorrhage (PPH) is a leading cause of maternal mortality. Its first-line of prevention often entails uterotonic drugs like oxytocin and misoprostol which constitute a core point of management in low-resource settings of sub-Saharan Africa. This study aimed to assess the effectiveness of oxytocin alone compared with oxytocin plus misoprostol in two different eras (before and after the advert of misoprostol) of a semi-urban Cameroonian hospital.Methods:This was a retrospective cohort study carried out between January 2015 to April 2015 and between January 2016 to April 2016 on a group of parturients (group A) who received only oxytocin and another administered oxytocin and misoprostol (group B), respectively. All participants delivered at the Bamenda Regional Hospital, Cameroon. The two different periods represent the era before and after the implementation of misoprostol in the prevention of PPH in this semi-urban hospital. Socio-demographic data, clinical characteristics and details of delivery as well as risk factors for PPH were studied from obstetric records.Results:We studied the obstetric records of 1778 parturients were studied; 857 in group A and 879 in group B. Their mean age was 26.3 ±5.2 years. Both groups were comparable in several baseline sociodemographic and clinical characteristics. The prevalence of PPH was 2.7% (3.4% vs 2.2%; p = 0.0744). The risk of PPH in the oxytocin only group was about 1.5 times higher than in the oxytocin plus misoprostol group. The estimated blood loss between the two groups was statistically significant (1100 ± 150 vs 800 ± 100 ml, p< 0.0001). The active management of the third stage of labor without misoprostol was the only risk factor for PPH.Conclusion and Global Health Implications:The implementation of misoprostol plus oxytocin in the prevention of PPH in this low-resource setting improved the obstetrical outcome by reducing the risk and the amount of blood loss during delivery.
Highlights
IntroductionPostpartum hemorrhage (PPH) is a life-threatening obstetric emergency that occurs after cesarean section (CS) or normal vaginal delivery (NVD)
In Cameroon, an sub-Saharan Africa (SSA) country, many interventions still need to be done to decrease the contemporary maternal mortality ratio (MMR) from 789 per 100, 000 live births to the targeted global MMR of less than 70 per 100,000 live births by the year 2030.8 The way forward partly entails curbing the burden of Post-partum hemorrhage (PPH) which has been reported as the primary cause of maternal deaths in many hospital-based audit reports,[8,9] as well as tackling a composite of factors which further contribute to a high MMR in this country such as inadequate antenatal care coverage,[8] late hospital presentation of parturients with obstetrical complications, the relatively high cost of health care poverty and the absence of a national health insurance policy.[9]
1778 files corresponding to 86.5% of the initial records retrieved were retained for this study.The files were repartitioned as follows: 857 in the oxytocin only group and 879 in the oxytocin plus misoprostol group
Summary
Postpartum hemorrhage (PPH) is a life-threatening obstetric emergency that occurs after cesarean section (CS) or normal vaginal delivery (NVD) It is defined as a blood loss of ≥ 500mls after a vaginal delivery or 1000mls after a cesarean delivery.[1] Worldwide, evidence abounds that PPH is the leading cause of maternal mortality, claiming 480,000 global maternal deaths between 2003 to 2009, of which 41.6% of these PPH-related maternal deaths occurred in sub-Saharan Africa (SSA).[2,3,4,5,6,7] in Cameroon, an SSA country, many interventions still need to be done to decrease the contemporary maternal mortality ratio (MMR) from 789 per 100, 000 live births to the targeted global MMR of less than 70 per 100,000 live births by the year 2030.8 The way forward partly entails curbing the burden of PPH which has been reported as the primary cause of maternal deaths in many hospital-based audit reports,[8,9] as well as tackling a composite of factors which further contribute to a high MMR in this country such as inadequate antenatal care coverage,[8] late hospital presentation of parturients with obstetrical complications, the relatively high cost of health care poverty and the absence of a national health insurance policy.[9] Efforts to curb PPH-related maternal mortality have focused on several medical treatments, mechanical or non-pharmacological measures, uterus preserving surgeries surgery or hysterectomy.[10]. Its first-line of prevention often entails uterotonic drugs like oxytocin and misoprostol which constitute a core point of management in low-resource settings of sub-Saharan Africa.This study aimed to assess the effectiveness of oxytocin alone compared with oxytocin plus misoprostol in two different eras (before and after the advert of misoprostol) of a semi-urban Cameroonian hospital
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