Volume 122, Issue 1 p. 22-26
Clinical articles

Injections during labor and intrapartum-related hypoxic injury and mortality in rural southern Nepal

Luke C. Mullany

Corresponding Author

Luke C. Mullany

Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

Corresponding author at: Department of International Health, 615 N. Wolfe Street, Suite W5009C, Baltimore, MD 21 228, USA. Tel.: + 1 410 502 2626; fax: + 1 410 955 7017.Search for more papers by this author
Subarna K. Khatry

Subarna K. Khatry

Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

Nepal Nutrition Intervention Project–Sarlahi, Kathmandu, Nepal

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Joanne Katz

Joanne Katz

Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

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Cynthia K. Stanton

Cynthia K. Stanton

Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

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Anne C.C. Lee

Anne C.C. Lee

Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

Department of Newborn Medicine, Brigham and Women's Hospital, Boston, USA

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Gary L. Darmstadt

Gary L. Darmstadt

Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

Family Health Division, Bill and Melinda Gates Foundation, Seattle, USA

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Steven C. LeClerq

Steven C. LeClerq

Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

Nepal Nutrition Intervention Project–Sarlahi, Kathmandu, Nepal

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James M. Tielsch

James M. Tielsch

Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

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First published: 21 March 2013
Citations: 7

Abstract

Objective

To estimate the association between unmonitored use of injections during labor and intrapartum-related neonatal mortality and morbidity among home births.

Methods

Recently delivered women in Sarlahi, Nepal, reported whether they had received injections during labor. Data on breathing and crying status at birth, time to first breath, respiratory rate, sucking ability, and lethargy were gathered. Neonatal respiratory depression (NRD) and encephalopathy (NE) were compared by injection receipt status using multivariate regression models.

Results

Injections during labor were frequently reported (7108 of 22 352 [31.8%]) and were predominantly given by unqualified village “doctors.” Multivariate analysis (excluding facility births and complicated deliveries) revealed associations with intrapartum-related NRD (relative risk [RR] 2.52; 95% CI, 2.29–2.78) and NE (RR 3.48; 95% CI, 2.46–4.93). The risks of neonatal death associated with intrapartum-related NRD (RR 3.78; 95% CI, 2.53–5.66) or NE (RR 4.47; 95% CI, 2.78–7.19) were also elevated.

Conclusion

Injection during labor was widespread at the community level. This practice was associated with poor outcomes and possibly related to the inappropriate use of uterotonics by unqualified providers. Interventions are required to increase the safety of childbirth in the community and in peripheral health facilities.

Parent trial registered at clinicaltrials.gov (NCT00 109616).