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Antenatal Uterotonics as a Risk Factor for Intrapartum Stillbirth and First-day Death in Haryana, India: A Nested
Sanjana Brahmawar Mohan1, Halvor Sommerfelt2,3, J Frederik Frøen2,3
1From the Centre for Health Research and Development, Society for Applied Studies (SAS), New Delhi, India.
Epidemiology (Cambridge, Mass.)
|July 4, 2020
Summary
Antenatal use of uterotonics, drugs that induce labor, significantly increases the risk of stillbirth and early neonatal death. This finding highlights the need for careful monitoring during pregnancy and labor to ensure fetal well-being.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Public Health
Background:
- Uterotonics like oxytocin can reduce fetal oxygen supply.
- Antenatal uterotonic use is common but its risks are not well-quantified.
- Previous studies suggest a potential link to stillbirth and neonatal asphyxia.
Purpose of the Study:
- To estimate the risk of intrapartum stillbirth and early neonatal death associated with antenatal uterotonic use.
- To quantify the population attributable risk of these adverse outcomes.
Main Methods:
- Population-based case-control study nested within a cluster-randomized trial in rural India (2008-2010).
- Follow-up of pregnant women and infants until day 29 postpartum.
- Verbal autopsies used for stillbirths and neonatal deaths; cases were early deaths (intrapartum stillbirths and day-1 deaths), controls were late deaths (day 8-28).
Main Results:
- Antenatal uterotonic administration was recorded in 74% of early deaths and 62% of late deaths.
- Adjusted odds ratio for early deaths was 1.7 (95% CI: 1.4, 2.1).
- Population attributable risk for early deaths was 31% (95% CI: 22%, 38%).
Conclusions:
- Antenatal uterotonic administration is linked to a significantly increased risk of intrapartum stillbirth and early neonatal death.
- Findings underscore the importance of fetal monitoring and cautious use of uterotonics during pregnancy.
- This study provides crucial data on the risks associated with widespread antenatal uterotonic use in low-resource settings.
