title: Direct observation of uterotonic drug use at public health facility-based deliveries in four districts in India.
abstract: OBJECTIVE
  To describe intrapartum uterotonic drug use and related behaviors in public health facility-based deliveries and to describe drug storage conditions in associated pharmacies.
  
  
  METHODS
  A descriptive study was conducted between August and November 2011 to document practices related to uterotonic administration and storage based on direct observation of deliveries at public health facilities in four Indian districts (n=97, n=89, n=91, and n=89) with contrasting maternal health and socioeconomic indicators.
  
  
  RESULTS
  Uterotonic drug use before and after delivery was common among the 366 study participants. Labor augmentation rates ranged from 53.5%-93.0% of deliveries across districts, with many receiving multiple uterotonics and administration via intramuscular injection or intravenous push. Uterotonic use following delivery ranged from 78.6%-99.1% across districts, with correct use of uterotonics for postpartum hemorrhage prevention varying from 6.0%-8.8% in Uttar Pradesh and 41.2%-76.4% in Karnataka. Active management of the third stage of labor following Indian guidelines was less than 10% in all districts. Storage of uterotonics at room temperature was common.
  
  
  CONCLUSIONS
  Given that labor augmentation is nearly routine and at odds with Indian guideline recommendations, rigorous research is needed to assess maternal and fetal outcomes of current versus guidelines-based practice. Active management of the third stage of labor as per Indian guidelines was minimal.
authors.affiliation: Department of Population, Family Planning and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. Electronic address: cstanton@jhsph.edu.
authors.forename: Cynthia K
authors.initials: CK
authors.lastname: Stanton
authors.affiliation: PATH, New Delhi, India.
authors.forename: Nitya N
authors.initials: NN
authors.lastname: Deepak
authors.affiliation: Department of Obstetrics and Gynecology, S. Nijalingappa Medical College and Hanagal Shri Kumareshwar Hospital, Bagalkot, India.
authors.forename: Ashalata A
authors.initials: AA
authors.lastname: Mallapur
authors.affiliation: Department of Obstetrics and Gynecology, S. Nijalingappa Medical College and Hanagal Shri Kumareshwar Hospital, Bagalkot, India.
authors.forename: Geetanjali M
authors.initials: GM
authors.lastname: Katageri
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
authors.forename: Luke C
authors.initials: LC
authors.lastname: Mullany
authors.affiliation: Department of Population, Family Planning and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
authors.forename: Alissa
authors.initials: A
authors.lastname: Koski
authors.affiliation: Department of Population, Family Planning and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
authors.forename: Ellie
authors.initials: E
authors.lastname: Mirzabagi
mesh_terms: D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007194:India; D007751:Labor, Induced / Q000706:statistics & numerical data*; D010120:Oxytocics; D006473:Postpartum Hemorrhage / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011247:Pregnancy
chemical_list: D010120:Oxytocics
keywords: Active management of the third stage of labor; Drug storage; India; Labor augmentation; Methylergometrine; Misoprostol; Oxytocin; Uterotonics