title: Perinatal mortality associated with use of uterotonics outside of Comprehensive Emergency Obstetric and Neonatal Care: a cross-sectional study.
abstract: BACKGROUND
  Prior studies have shown that using uterotonics to augment or induce labor before arrival at comprehensive Emergency Obstetric and Neonatal Care (CEmONC) settings (henceforth, "outside uterotonics") may contribute to perinatal mortality in low- and middle-income countries. We estimate its effect on perinatal mortality in rural Bangladesh.
  
  
  METHODS
  Using hospital records (23986 singleton term births, Jan 1, 2009-Dec 31, 2015) from rural Bangladesh, we use a logistic regression model to estimate the increased risk of perinatal death from uterotonics administered outside a CEmONC facility.
  
  
  RESULTS
  Among term births (≥37 weeks gestation), the risk of perinatal death adjusted for key confounders is significantly increased among women reporting uterotonic use outside of CEmONC (OR = 3 · 0, 95 % CI = 2 · 4,3 · 7). This increased risk is particularly high for fresh stillbirths (OR = 4 · 0, 95 % CI = 3 · 0,5 · 3) and intrapartum-related causes of early neonatal deaths (birth asphyxia) (OR = 3 · 1, 95 % CI = 2 · 2,4 · 5).
  
  
  CONCLUSIONS
  In this sample, outside uterotonic use was associated with substantially increased risk of fresh stillbirths, deaths due to birth asphyxia, and all perinatal deaths. In settings of high uterotonic use outside of controlled settings, substantial improvement in both stillbirth and early neonatal mortality may be made by reducing such use.
authors.affiliation: LAMB MIS-Research Department, Parbatipur, Dinajpur, 5250, Bangladesh. louisetday@gmail.com.|LAMB Hospital Pediatric Department, Parbatipur, Dinajpur, 5250, Bangladesh. louisetday@gmail.com.
authors.forename: Louise T
authors.initials: LT
authors.lastname: Day
authors.affiliation: Arizona State University, Tempe, AZ, 85287, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hruschka
authors.affiliation: LAMB Hospital Obstetric Department, Parbatipur, Dinajpur, 5250, Bangladesh.
authors.forename: Felicity
authors.initials: F
authors.lastname: Mussell
authors.affiliation: Arizona State University, Tempe, AZ, 85287, USA.
authors.forename: Eva
authors.initials: E
authors.lastname: Jeffers
authors.affiliation: LAMB MIS-Research Department, Parbatipur, Dinajpur, 5250, Bangladesh.
authors.forename: Stacy L
authors.initials: SL
authors.lastname: Saha
authors.affiliation: LAMB MIS-Research Department, Parbatipur, Dinajpur, 5250, Bangladesh.
authors.forename: Shafiul
authors.initials: S
authors.lastname: Alam
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004363:Drug Utilization / Q000706:statistics & numerical data; D004630:Emergencies; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000139:chemically induced / Q000453:epidemiology; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects*; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods; D012423:Rural Health / Q000706:statistics & numerical data; D050497:Stillbirth / Q000453:epidemiology
chemical_list: D010120:Oxytocics
keywords: Bangladesh; Child survival; Neonatal death; Perinatal mortality; Stillbirth; Under-five mortality; Uterotonics