A new study published in PLOS Medicine,“Effect on Postpartum Hemorrhage of Prophylactic Oxytocin (10 IU) by Injection by Community Health Officers in Ghana: A Community-Based, Cluster-Randomized Trial” documents the findings of a project led by Cynthia Stanton of The Johns Hopkins Bloomberg School of Public Health, which introduced a potentially promising approach for efforts to prevent postpartum hemorrhage in settings where women give birth at home, without the equipment or assistance of a skilled birth attendant needed to protect them from life-threatening bleeding. The study suggests important potential for addressing a critical barrier to ensuring that women receive oxytocin, which generally requires both cold storage and administration via saline drip: by using the Uniject system, which offers both temperature monitoring and a means to deliver medications using a safe, single-dose injection; and by relying on community health officers, a cadre of health workers who are not trained in midwifery skills, to administer the injections, the study offers important promise for informing future efforts to reduce postpartum hemorrhage. From the article:
The researchers found that the women who were given a preventative oxytocin injection lost less blood after birth than the women who did not receive a preventative injection. There were also fewer cases of PPH amongst the women who received oxytocin for PPH prevention. 2.6% of the women who received a preventative oxytocin injection experienced PPH, compared to 5.5% of the controls. Therefore the risk of PPH was approximately halved. There were no cases of oxytocin use before delivery of the baby and no difference in the frequency of other birth complications between women in the intervention and control groups. These findings show that under the trial conditions, CHOs can safely administer oxytocin injections when attending home births in poor, rural settings. This intervention also proved practical to use in the Uniject format.
Along with the article documenting the trial’s promising results, PLOS Medicine also features a commentary by João Paulo Souza of the WHO Department of Reproductive Health and Research on the study’s implications for further efforts to reduce the toll of postpartum hemorrhage. He argues:
Successful completion of this challenging trial is important because it demonstrates the feasibility, safety, and impact of a community-based PPH prevention strategy. It should be noted that this evidence contributes to equity in health as it extends the application of the most efficacious uterotonic for PPH prevention to the community and under-resourced settings. Based on this evidence, prophylactic oxytocin can be offered by community health officers to all women during the third stage of labor. However, the use of a disposable pre-filled syringe only partially solves the problems related to using oxytocin in under-resourced settings. Cold supply chain issues remain an important obstacle and the skills to administer an IM injection (although simplified) are still required. Thus, investment in the research and development of a thermostable and similarly effective uterotonic is highly desirable. Efforts should be dedicated to optimize the use of cold supply chain for health products at the country level (e.g., harmonizing vaccines’ and oxytocin’s cold supply chains), and the capacity of community health officers to administer IM injections should be strengthened. Another major limiting factor is the fact that oxytocin in Uniject is not commercially available, and the industrial capacity needs to be established or expanded for meeting the demand of large scale implementation programs.
Further, he notes that while remarkably important to reducing the burden of postpartum hemorrhage, expanding access and use of uterotonics like oxytocin is essential, strengthening health systems in order to ensure that women receive the treatment they need remains an central, essential challenge.