title: Bedside Availability of Prepared Oxytocin and Rapid Administration After Delivery to Prevent Postpartum Hemorrhage: An Observational Study in Karnataka, India.
abstract: Postpartum hemorrhage is a leading cause of maternal death worldwide. Rapid provision of uterotonics after childbirth is recommended to reduce the incidence and severity of postpartum hemorrhage. Data obtained through direct observation of childbirth practices, collected in a study of the World Health Organization's Safe Childbirth Checklist in Karnataka, India, were used to measure if oxytocin prepared for administration and available at the bedside before birth was associated with decreased time to administration after birth. This was an observational study of provider behavior: data were obtained during a baseline assessment of health worker practices prior to introduction of the Safe Childbirth Checklist, representing behavior in the absence of any intervention. Analysis was based on 330 vaginal deliveries receiving oxytocin at any point postpartum. Oxytocin was prepared and available at bedside for approximately 39% of deliveries. We found that advance preparation and bedside availability of oxytocin was associated with increased likelihood of oxytocin administration within 1 minute after delivery (adjusted risk ratio = 4.89, 95% CI = 2.61, 9.16), as well as with decreased overall time to oxytocin administration after delivery (2.9 minutes sooner in adjusted models, 95% CI = -5.0, -0.9). Efforts to reduce postpartum hemorrhage should include recommendations and interventions to ensure advance preparation and bedside availability of oxytocin to facilitate prompt administration of the medicine after birth.
authors.affiliation: Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, MA, USA.
authors.forename: Corrina
authors.initials: C
authors.lastname: Moucheraud
authors.affiliation: Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Gass
authors.affiliation: Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, USA Brigham and Women's Hospital, Center for Surgery and Public Health, Boston, MA, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Lipsitz
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Spector
authors.affiliation: Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, MA, USA London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK.
authors.forename: Priya
authors.initials: P
authors.lastname: Agrawal
authors.affiliation: Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, USA Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, USA.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Hirschhorn
authors.affiliation: Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, USA Brigham and Women's Hospital, Center for Surgery and Public Health, Boston, MA, USA.
authors.forename: Atul
authors.initials: A
authors.lastname: Gawande
authors.affiliation: Jawaharlal Nehru Medical College, Women's and Children's Health Research Unit, Karnataka, India.
authors.forename: Bhala
authors.initials: B
authors.lastname: Kodkany
mesh_terms: D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D007194:India; D010120:Oxytocics / Q000627:therapeutic use*; D010121:Oxytocin / Q000627:therapeutic use*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D013997:Time Factors
chemical_list: D010120:Oxytocics; D010121:Oxytocin