OXYTOCICS IN DEVELOPING-COUNTRIES

Objectives. A prospective multicenter study of obstetric practices was conducted in three developing countries (Benin, Congo and Senegal) to analyze oxytocic use during labor. One of the objectives was to asses s the possible negative effects of the treatment regimens instituted d uring the labor monitoring phase. Methods: Four health districts parti cipated in the study. All women who gave birth in one of the participa ting health facilities over a 6-month period in Benin and Congo, and o ver a 3-month period in Senegal, were recruited. The number of deliver ies studied in each district varied from 457 to 1048. For each case a partogram was used to assess the progress of labor and the onset of dy sfunctional labor, Information was collected on the risk factors for d ysfunctional labor, stillbirths and resuscitation of the neonate. Resu lts: Each of the four collaborating centers used oxytocics preferentia lly to treat dysfunctional labor, but even in normal labor (i.e. with a normal partogram) oxytocics were used in 4.4-21.5% of cases. In norm al labor the incidence of neonatal resuscitation was higher in cases w ith than in those without oxytocic use: the relative risks (R.R.) vari ed from 1.9 to 5.6; the odds ratios varied from 2.4 to 7.0: and both w ere statistically significant in the four settings, In addition the st illbirth rate was always higher, though not significantly, when oxytoc ics were used in normal labor (R.R. 1.2-2.2). When the data of the fou r centers were pooled, the global relative risk for stillbirths was 1. 9, and the 95% confidence interval was 1.1-3.4. Logistic regression an alysis was carried out for five confounding factors (primiparity, a pr evious complicated delivery, presence of meconium, ruptured membranes and educational level) to adjust the odds ratio for the risk of neonat al resuscitation when oxytocics were used in normal labor. Except in t he case of Abomey in Benin, where the variable 'presence of meconium' decreased the odds ratio from 6.4 to 3.4, the adjusted odds ratios rem ained similar to their non-adjusted values. In cases of non-dysfunctio nal labor, nurses and midwives used oxytocics more often than lesser t rained health personnel (R.R. 4.0 [3.2-5.1]). Conclusion. Our results show that an obstetric treatment which is safe when used in certain we ll-defined indications, may have significant negative effects when use d in situations where the same technical quality of care cannot be gua ranteed.