title: Injections during labor and intrapartum-related hypoxic injury and mortality in rural southern Nepal.
abstract: OBJECTIVE
  To estimate the association between unmonitored use of injections during labor and intrapartum-related neonatal mortality and morbidity among home births.
  
  
  METHODS
  Recently delivered women in Sarlahi, Nepal, reported whether they had received injections during labor. Data on breathing and crying status at birth, time to first breath, respiratory rate, sucking ability, and lethargy were gathered. Neonatal respiratory depression (NRD) and encephalopathy (NE) were compared by injection receipt status using multivariate regression models.
  
  
  RESULTS
  Injections during labor were frequently reported (7108 of 22352 [31.8%]) and were predominantly given by unqualified village "doctors." Multivariate analysis (excluding facility births and complicated deliveries) revealed associations with intrapartum-related NRD (relative risk [RR] 2.52; 95% CI, 2.29-2.78) and NE (RR 3.48; 95% CI, 2.46-4.93). The risks of neonatal death associated with intrapartum-related NRD (RR 3.78; 95% CI, 2.53-5.66) or NE (RR 4.47; 95% CI, 2.78-7.19) were also elevated.
  
  
  CONCLUSIONS
  Injection during labor was widespread at the community level. This practice was associated with poor outcomes and possibly related to the inappropriate use of uterotonics by unqualified providers. Interventions are required to increase the safety of childbirth in the community and in peripheral health facilities. Parent trial registered at clinicaltrials.gov (NCT00 109616).
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21228, USA. lmullany@jhsph.edu
authors.forename: Luke C
authors.initials: LC
authors.lastname: Mullany
authors.forename: Subarna K
authors.initials: SK
authors.lastname: Khatry
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
authors.forename: Cynthia K
authors.initials: CK
authors.lastname: Stanton
authors.forename: Anne C C
authors.initials: AC
authors.lastname: Lee
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
authors.forename: Steven C
authors.initials: SC
authors.lastname: LeClerq
authors.forename: James M
authors.initials: JM
authors.lastname: Tielsch
mesh_terms: D000293:Adolescent; D000328:Adult; D001238:Asphyxia Neonatorum / Q000453:epidemiology / Q000209:etiology; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005311:Fetal Hypoxia / Q000453:epidemiology / Q000209:etiology; D006700:Home Childbirth / Q000379:methods* / Q000592:standards; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007267:Injections; D007743:Labor, Obstetric; D008297:Male; D015999:Multivariate Analysis; D009390:Nepal; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects; D011247:Pregnancy; D011256:Pregnancy Outcome; D019035:Rural Health Services / Q000592:standards / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D010120:Oxytocics