From darmbruster at path-dc.org Tue Mar 7 05:51:26 2006 From: darmbruster at path-dc.org (Armbruster, Deborah) Date: Tue Mar 7 15:01:49 2006 Subject: [Preventing_postpartum_hemorrhage] RE: listserv posting Message-ID: Welcome to Prevention of Postpartum Hemorrhage list-serve members. As stated in the sign-up notice, this list-serve will provide an opportunity for members to share information and for the POPPHI project to share and, periodically, ask for comments and suggestions on topics of interest. Topic: Uterotonics or Oxytocic Drugs: Practical Guidance for Health Care Providers in Low-resource Settings Through POPPHI's work on the prevention of postpartum hemorrhage (PPH), we have listened and learned of the difficulties faced by health workers in the field in using and storing uterotonic drugs-drugs that cause the uterine muscles to contract. These drugs are essential for preventing PPH through active management of the third stage of labor or for treatment of PPH. Information on using, managing, and storing uterotonics has not reached many maternity care providers working in low-resource settings. While these drugs are essential to the practice of active management of the third stage of labor and in the prevention of postpartum hemorrhage, health workers face a series of difficulties. They either do not have access to or an adequate supply of oxytocin for active management of the third stage of labor and for the treatment of PPH, and/or do not know that ergometrine, in particular, is very temperature and light sensitive. Many health providers, pharmacists, and ministry of health personnel do not have access to current information from WHO stating that oxytocin is the drug of choice for active management of the third stage of labor and an important drug in treatment of postpartum hemorrhage as well. In response to the requests from the field, POPPHI is working to address this issue. In our review of the literature, we identified a World Health Organization (WHO) 1993 document as a key resource with this information. Please click here for a link to the study on the results of field surveys and simulation studies on ergometrine, methylergometrine, and oxytocin (http://www.pphprevention.org/publications.php, scroll down to Technical Briefs). We have used this article to develop practical guidance for the field. Click here to review a four-page draft document entitled, Use of uterotonic drugs for prevention and treatment of postpartum hemorrhage in tropical climates: Guidance for essential drug and safe motherhood programs, (http://www.pphprevention.org/publications.php, scroll down to Technical Briefs) that we have developed to provide practical guidance to the field in the management and storage of these oxytocic drugs: oxytocin and ergometrine. We ask for your comments on this draft document and hope to generate discussion around this issue of the availability, management, and storage of the oxytocics. We hope that this will start a discussion on the not only these draft guidelines but more generally on the issue of proper management and storage of uterotonics. While misoprostol is a uterotonic drug that is an alternative to oxytocin for use in active management of the third stage of labor, we will not be discussing misoprostol in this issue. Elbourne DR, Prendiville WJ, Carroli G, Wood J, McDonald S. Prophylactic use of oxytocin in the third stage of labour. The Cochrane Library. 2004;3:1-47. Related works: Hogerzeil HV, Walker GJA, de Goeje MJ. Stability of injectable oxytocics in tropical climates. Geneva: World Health Organization, 1003; WHO/DPA/93.6. Hogerzeil HV, Walker GJA. Oxytocin more stable in tropical climates (letter). British Medical Journal. 1994;308:59. Hogerzeil HV, Walker G. Instability of (methyl)ergometrine in tropical climates: an overview. European Journal of Obsetrics & Gynecology and Reproductive Biology. 1996;69:25-29. Deborah Armbruster Meghan Greeley Director, POPPHI Project Program Assistant PATH PATH 1800 K St. NW, Suite 800 1800 K St. NW, Suite 800 Washington, DC 20006 Washington DC 20006 Tel: 202 - 822-0033 Tel: 202-822-0033 Fax: 202-457-1466 Fax: 202-457-1466 mgreeley@path-dc.org mgreeley@path-dc.org