IN ITS battle to reduce maternal mortality rate in the country, the government will have to consider seriously post partum haemorrhage, stated to cause 30 per cent of maternal deaths in India.
The recommendation of the drug misoprostol (to induce uterine contractions) in its Reproductive Child Health Project 2, though yet to be implemented, is an effort to handle post-delivery bleeding and ensure that it does not lead to death. While the RCH programme has not yet begun to dispense misoprostol, a recently-published study in The Lancet has proved that giving the commonly available low-cost tablet to the mother within five minutes of delivery resulted in a significant reduction in the rate of post partum haemorrhage and even blood loss. It further recommends that the "drug's low cost, ease of administration, stability and a positive safety profile makes it a good option in resource-poor settings." A team of researchers from the Jawaharlal Nehru Medical College, Belgaum, National Institutes of Health and University of Missouri conducted the study among 1,620 women in Belgaum to examine if the drug, used more popularly to prevent bleeding ulcers, provided an effective way to prevent PPH. About 50 per cent of births in rural India occur at home, either attended or unattended by trained paramedical personnel, Dr.Bhalchandra Kodkany, faculty from the JNMC, Belgaum, and investigator in the study told The Hindu.
While in urban areas, where incidentally, institutional deliveries are more common, the drug oxytoxin is administered to stop bleeding in the uterus, it requires cold chain facilities for storage, which might not be available in rural areas. Auxiliary Nurse Midwives who attend on deliveries that take place at home were trained to give three tablets of the drug or a placebo soon after delivery and then monitor the mothers for two hours after delivery, Dr.Kodkany said. In fact the strength of the study, he added, was that it had established the ability to use midwives in administering misoprostol and reducing PPH, and consequently, deaths.Misoprostol nearly halved the percentage of women suffering from acute PPH, the study revealed. Only 6.4 per cent of the women who were given the drug suffered from acute PPH, in comparison with 12 per cent among those given placebos. Overall, one case of postpartum haemorrhage was prevented for every 18 women treated, according to an NIH communique.
Blood loss reduced
The volume of blood loss after delivery was also reduced. Though more women taking the drug experienced shivering and fever, compared to those on the placebo, the effects were temporary and there was no evidence of adverse effects on the babies. NIH director Elias Zerhouni, in response to the the study results said, "This advance has the potential to save thousands of lives every year."