Dystocia (i.e., births problem) continue to cause significant maternal mortality in low-income countries, particularly in sub-Saharan Africa.
Oxytocin has long been successfully used for the treatment of some dystocia and for the treatment of post-partum hemorrhage (i.e. hemorrhage occurring just after childbirth), but its use is made difficult by its chemical instability and sensitivity to external conditions and by the presence of low quality or low grade oxytocin in the market.
Oxytocin should be stored away from light and at a temperature between 2 and 8° (it should never be frozen). Unrefrigerated, it gradually loses its activity. In concrete terms, gynecologists and/or midwives who have unknowingly administered a low-grade oxytocin infusion into a parturient (i.e. a woman in labour) for a dystocia delivery find that the expected effect does not occur; they are then obliged, for lack of an alternative, to increase the dose of oxytocin to achieve the expected effect, which complicates the management of the parturient and increases costs.
Recent studies have been conducted in Nigeria and Malawi to test the quality of oxytocin administered to parturients, but without analyzing the consequences of administering a low-quality oxytocin to parturients.
With regard to the potency of the oxytocin ampoules in the market (samples were taken from private pharmacies and various maternity wards), the study carried out in Malawi revealed that, in 11% of the oxytocin ampoules analyzed, the level of active product ranged from 82% to 87% compared to normal; a relatively good but insufficient result.
With regard to the conservation of oxytocin, two studies have found that breaks in the cold chain also occur in the maternity ward itself.
In Malawi, a survey found that oxytocin storage temperature was exceeded in 42% of facilities without a refrigerator and in 33% of facilities with a refrigerator.
In Nigeria, a survey found that only 52% of staff interviewed knew that oxytocin should be stored between 2°C and 8°C.
When doctors or midwives had doubts about the quality of oxytocin used, they rarely reported the fact to health authorities for action.
Recommendations of AEFJN
The National Pharmacy Inspectorate must adequately verify the quality of oxytocin offered for sale before granting marketing authorization.
Maintaining the cold chain to preserve oxytocin – but this also applies to many vaccines and other health products – remains a major challenge in the distribution of heat-sensitive health products in Africa. In particular, it requires resources, knowledge and vigilance on the part of a large number of stakeholders down to the most peripheral level.
Training of health personnel in the preservation of heat-sensitive medicines and health products is a priority.
Declarations concerning the questionable quality of health products made by hospitals and health centres to the health hierarchy should be organized or reinforced.
Dr. Christian Roberti
Find out more