Sudan Journal of Medical Sciences

ISSN: 1858-5051

High-impact research on the latest developments in medicine and healthcare across MENA and Africa

Evaluation of the Adherence of Obstetricians to International Guidelines for Dispensing Misoprostol and Oxytocin in Saad Abu Ella Maternity Hospital: A Retrospective Study

Published date: Jun 25 2020

Journal Title: Sudan Journal of Medical Sciences

Issue title: Sudan JMS: Volume 15 (2020), Issue No. 2

Pages: 171–183

DOI: 10.18502/sjms.v15i2.6885

Authors:

Mona Hashim Elbashir monahashim955@gmail.comDepartment of Clinical Pharmacy, Faculty of Pharmacy, University of Khartoum

Safaa Badisafaabadi30@gmail.comDepartment of Clinical Pharmacy, Faculty of Pharmacy, Omdurman Islamic University

Muhammad Abdou AbdulraheemMuhammad.abdou@outlook.comDepartment of Clinical Pharmacy, Faculty of Pharmacy, Omdurman Islamic University

Bashir Alsiddig Yousefbashiralsiddiq@gmail.comDepartment of Pharmacology, Faculty of Pharmacy, University of Khartoum

Abstract:

Background: Misoprostol and oxytocin are commonly prescribed drugs by obstetricians to induce labor and prevent postpartum hemorrhage. In Sudan, there is no national guideline for prescribing these drugs. Thus, the prescribers follow the international guidelines. Hence, our study aimed to evaluate the adherence of Sudanese obstetricians to the international guidelines for dispensing misoprostol and oxytocin.

Methods: A retrospective descriptive hospital-based study was performed at Saad Abu Ella hospital through their medical files archived in 2018 using a checklist designed by the researcher. Collected data were analyzed and presented in frequency tables using the statistical package for social sciences (SPSS).

Results: A total of 357 medical files were evaluated, about 50% of cases examined was in the 25–35 years age range, multigravida pregnant ladies were 62%. General indications of oxytocin and/or misoprostol were induction of labor (17%), postpartum hemorrhage prevention (PPH) after normal vaginal delivery (NVD) (30%) and cesarean sections (32%), evacuation of incomplete miscarriage (20%), and termination of pregnancy (1%). Compared to the guidelines, only 14% were given the recommended regimens for labor induction; 9.4% of women who had undergone NVD were given the recommended regimen to prevent PPH. While, 57% and 43% of the cases with incomplete miscarriage and termination of pregnancy were given the recommended regimens, respectively. Based on the correct indication, total adherence was estimated to be 17%.

Conclusions: Higher percentages of cases with incomplete miscarriage and intrauterine fetal death were given the recommended regimens to manage them. While, lower percentages of the participants were given the recommended regimens for labor induction and to prevent PPH. 

Key words: misoprostol, oxytocin, obstetricians, adherence, international guidelines

References:

[1] Spinner, M. R. (1978). Maternal-infant bonding. Canadian Family Physician, vol. 24, pp. 1151–1153.
[2] Jacob, A. (2012). A Comprehensive Textbook of Midwifery and Gynecological Nursing: JP Medical Ltd.
[3] ACOG Committee on Practice Bulletins – Obstetrics. (2009). ACOG Practice Bulletin No. 107: Induction of labor. Obstetrics & Gynecology, vol. 114, no. 2, pt 1, pp. 386–397.
[4] Stanton, C. and Ronsmans, C. (2008). Caesarean birth as a component of surgical services in low- and middle-income countries. Bulletin of the World Health Organization, vol. 86, no. 12, A.
[5] Murphy, F. A., Lipp, A., and Powles, D. L. (2012). Follow-up for improving psychological well-being for women after a miscarriage. Cochrane Database of Systematic Review, vol. 14.
[6] Duckworth, H. L. and Stanley, K. P. (2011). Induction of labour of intrauterine fetal death 24/40: audit of a UK teaching hospital’s practice over 1 year, prior to introduction of recent RCOG green-top guideline no. 55. Archives of Disease in Childhood - Fetal and Neonatal Edition, vol. 96, Fa89.
[7] Tsu, V. D. and Shane, B. (2004). New and underutilized technologies to reduce maternal mortality: call to action from a Bellagio workshop. International Journal of Gynecology & Obstetrics, vol. 85, p. 011.
[8] Hill, S., Yang, A., and Bero, L. (2012). Priority medicines for maternal and child health: a global survey of national essential medicines lists. PLOS ONE, vol. 7.
[9] WHO. (2003). Pregnancy, Childbirth, Postpartum, and Newborn Care: A Guide For Essential Practice. WHO.
[10] No G-tG. (2016). Prevention and management of postpartum haemorrhage. BJOG, vol. 124, pp. e106–e149.
[11] National Collaborating Centre for Women's and Children's Health (UK). (2008). Induction of Labour. London: RCOG Press. (NICE Clinical Guidelines, No. 70.). Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK53620/
[12] WHO. (2018). Medical Management of Abortion: Pocket Guide. WHO.
[13] Morris, J. L., Winikoff, B., Dabash, R., et al. (2017). FIGO's updated recommendations for misoprostol used alone in gynecology and obstetrics. International Journal of Gynecology & Obstetrics, vol. 138, pp. 363–366.
[14] WHO. (2012). WHO Recommendations For the Prevention and Treatment of Postpartum Haemorrhage. WHO.
[15] Galero-Tejero, E. (2011). A Simplified Approach to Thesis and Dissertation Writing, pp. 43–44. Mandaluyong City: National Book Store.
[16] WHO. (2011). Priority Medicines For Mothers and Children 2011. WHO.
[17] Olefile, K. M., Khondowe, O., and M'Rithaa, D. (2013). Misoprostol for prevention and treatment of postpartum haemorrhage: a systematic review. Curationis, vol. 36, p. 57.
[18] Simpson, K. R. and James, D. C. (2008). Effects of oxytocin-induced uterine hyperstimulation during labor on fetal oxygen status and fetal heart rate patterns. American Journal of Obstetrics and Gynecology, vol. 199, p. 14.
[19] Weeks, A. D., Fiala, C., and Safar, P. (2005). Misoprostol and the debate over off-label drug use. BJOG, vol. 112, pp. 269–272.
[20] Allen, R. and O'Brien, B. M. (2009). Uses of misoprostol in obstetrics and gynecology. Reviews in Obstetrics & Gynecology, vol. 2, pp. 159–¡68.
[21] Tang, O. S., Gemzell-Danielsson, K., and Ho, P. C. (2007). Misoprostol: pharmacokinetic profiles, effects on the uterus and side-effects. International Journal of Gynecology & Obstetrics, vol. 99, p. 26.
[22] RCOG. (2008). Induction of labour (NICE Clinical Guidelines, No. 70). London: RCOG Press.
[23] McCarthy, F. P. and Kenny, L. C. (2014). Induction of labour. Obstetrics, Gynaecology & Reproductive Medicine, vol. 24, pp. 9–15.
[24] Stanton, C., Armbruster, D., Knight, R., et al. (2009). Use of active management of the third stage of labour in seven developing countries. Bulletin of the World Health Organization, vol. 87, pp. 207–215.
[25] Ezechi, O. C., Loto, O. M., Ezeobi, P. M., et al. (2008). Safety and efficacy of misoprostol in induction of labour in prelabour rupture of fetal membrane in Nigerian women: a multicenter study. International Journal of Reproductive BioMedicine, vol. 6, pp. 83–90.
[26] Güngördük, K., Olgaç, Y., Gülseren, V., et al. (2018). Active management of the third stage of labor: a brief overview of key issues. Turkish Journal of Obstetrics and Gynecology, vol. 15, pp. 188–192.
[27] Maughan, K. L., Heim, S. W., and Galazka, S. S. (2006). Preventing postpartum hemorrhage: managing the third stage of labor. American Family Physician, vol. 73, pp. 1025–1028.
[28] Costa, S. H. and Vessey, M. P. (1993). Misoprostol and illegal abortion in Rio de Janeiro, Brazil. Lancet, vol. 341, pp. 1258–1261.
[29] Stanton, C., Armbruster, D., Knight, R., et al. (2009). Use of Active Management of the Third Stage of Labour in Seven Developing Countries. SciELO Public Health.

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