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Post-partum hemorrhage prevention in Central America: findings from the Salud Mesoamérica Initiative
Abstract Number: T3A-1
Abstract Type: Original Research
Introduction: Post-partum hemorrhage remains the leading cause of maternal mortality worldwide, accounting for 31% of total maternal deaths.1 International guidelines for post-partum hemorrhage recommend active management of third stage of labor, with emphasis on administering oxytocin, the uterotonic drug of choice, for prevention and treatment of uterine atony.2,3 The Salud Mesoamérica Initiative is a public-private partnership aimed at reducing maternal and child mortality for the poorest populations in Mesoamérica. To our knowledge, this study would be the first multinational study to examine the availability and administration of oxytocin over time for the prevention of post-partum hemorrhage in this region.
Methods: 213 basic and complete level health facilities in the countries of Belize, Guatemala, Honduras, Mexico (state of Chiapas), Nicaragua, and Panama participated in the study. Basic level facilities have the capacity to manage uncomplicated vaginal deliveries, while complete level facilities attend to complicated births, including transfers and cesarean sections. The health facility survey included an interview questionnaire of the facility infrastructure and resources, observation checklist of medical drugs and equipment, and review of medical records. It was conducted at the baseline (2011-2013) and first follow-up (2013-2014). Uncomplicated delivery medical records were extracted, using a systematic random sampling technique. Multivariable logistic regression analysis was used, adjusting for clustering at the hospital level to assess facility-level and patient-level factors of the availability and administration of oxytocin.
Results: The study included 3,325 deliveries. The sample included 213 facilities with 72.3% basic and 27.7% complete level facilities. Mean age of maternal patients was 24.4 years old, 52.3% were not married (or in a partnership), and 72.6% had less than a secondary education. Of these patients, 99.7% had a single gestational pregnancy and 97.3% delivered vaginally. Odds of availability (OR = 8.18 ; 95% CI = 5.60 - 11.95 and aOR = OR = 8.28; 95% CI = 1.82 – 37.77) and administration (OR = 1.51 ; 95% CI = 1.23 - 1.85 and aOR = OR = 1.76; 95% CI = 1.01 – 3.06) of oxytocin were higher in the follow-up as compared to baseline. Use of oxytocin was higher in Honduras and lower in the Mexican state of Chiapas. Type of health facility was not significantly associated with oxytocin use.
Conclusion: The Salud Mesoamérica Initiative has shown an increase in oxytocin availability and administration over time. Implementation of interventions, such as oxytocin supply and personnel training, is a feasible mean to improve post-partum hemorrhage in this region.
2. World Health Organization.2012:1-48.
3. International Journal of Gynecology and Obstetrics.2012;117:108-118.