Use of Oxytocin as Part of Active Management of Third Stage of Labor among Healthcare Providers in Northeast Argentina

1. Use of Oxytocin as Part of Active Management of Third Stage of Labor among Healthcare Providers in Northeast Argentina Connie Nguyen, MPH Candidate 2012 Tulane School of Public Health and Tropical Medicine New Orleans, Louisiana knguyen@tulane.edu

2. Postpartum Hemorrhage • Postpartum hemorrhage (PPH) is leading cause of maternal death in the world • To reduce PPH, active management of third stage of labor (AMTSL) is recommended as standard care • Uterine massage, controlled cord traction, and prophylactic uterotonic • Not being practiced correctly or even at all in many hospitals in developing world • In rural northeast Argentina, many hospitals are understaffed, and workers are not sufficiently trained in AMTSL

3. Study Settings • We conducted a study at five hospitals in the northeastern province of Corrientes, Argentina • Partnered with the Institute for Clinical Effectiveness and Health Policy of Buenos Aires through National Institutes of Health’s Minority Health and Health Disparities International Research Training

4. Objectives • Primary objective is to compare birth attendants' knowledge and opinion regarding AMTSL from before and after intervention The secondary objective is to assess the availability and storage conditions of prophylactic uterotonics at participating hospitals.

5. Study Design • Prospective before and after study without control group • Intervention to be evaluated consisted of distribution of Uniject devices, hospital reminders, and training sessions • Pre and post-intervention surveys distributed among medical workers in 5 hospitals in the region

6. Results • Increase in administration of oxytocin from 26.7% to 100.0% • After intervention, 96.9% contested yes to having administered oxytocin via Uniject • Oxytocin was available at all five hospitals during our visit and regarded as the uterotonic of choice • Clinical guidelines were present in the delivery rooms at all hospitals

7. Discussion • Overall increase in the use of AMTSL ensuing the intervention • Area with greatest increase was the administration of prophylactic oxytocin • Positive reaction towards using Uniject; increased administration of uterotonic

8. Limitations • Small sample size and no control group • Possible misinterpretation of data collection • Not all providers participated in both surveys • Some boxes of Uniject were found to be expired when we visited

9. Recommendations • If the results shown in this study can be replicated elsewhere in Latin America, this strategy could be an effective method to improve the use of prophylactic oxytocin in the management of third stage of labor • Necessary to administer additional surveys on a greater scale, perhaps in other provinces of Argentina to compare if the results remain consistent and to assess the discrepancies from this particular study

10. Acknowledgements • National Institute on Minority Health and Health Disparities, National Institutes of Health (United States) • Institute for Clinical Effectiveness and Health Policy (Buenos Aires, Argentina • Tulane School of Public Health and Tropical Medicine • Jose Belizan, MD, PhD • Pierre Buekens, MD, PhD • Fernando Althalbe, MD, MSc • Richard Oberhelman, MD • AgustinaMazzoni, MD, MSc • Luz Gibbons, MSc • AkleciaMcVoy, MPH