Systematic prophylactic oxytocin injection and the incidence of postpartum hemorrhage: A before-and-after study.

OBJECTIVE: Assess the impact of routine injection of 5 units of oxytocin as soon as the anterior shoulder is delivered on the incidence of postpartum haemorrhage (PPH) in a context of daily practice. MATERIALS AND METHODS: Single-centre before-and-after study evaluating the effect of a change in the protocol for PPH prevention as applied in our obstetrical unit. During the first period, oxytocin (5 units) was to be injected only in case of PPH risk factors. During the second period, the injection was systematic. RESULTS: In the "before" study period, there were 1953 patients vaginal deliveries and 843 (43%) oxytocin injections, with a protocol compliance of 85%. In the "after" study period, 2018 women had vaginal deliveries and 1911 (95%) had an oxytocin injection (protocol compliance: 95%). The whole study period was associated with a reduced risk of moderate haemorrhage (13.4% vs. 9.2%, P<0.001), but no significant reduced risk of severe haemorrhage was observed (2.1% vs. 2.0%, P=0.79). After logistic regression, the study period remained associated with a significant reduction in the risk of moderate PPH (OR=0.72 [0.58-0.89]). CONCLUSION: Routine injection of 5 units of oxytocin makes it possible to reduce the risk of moderate PPH, but it does not affect the risk of severe PPH.

[Breastfeeding: opinion and knowledge of pharmacists. A study in a semi-urban territory]. / Allaitement maternel : opinions et connaissances des pharmaciens dans la métropole lilloise.

BACKGROUND: Because of the French delay regarding breastfeeding compared to other Europeans countries, its promotion was one of the 9 specific nutritional goals of the 2001, 2006, and 2011 National Nutritional Health Program. The objective of this study was to establish the opinion and knowledge of pharmacists from a selected semi-urban territory of the Lille metropolitan area on breastfeeding. METHOD: The 33 pharmacies around the city of Villeneuve-d'Ascq were contacted. First, the goal and the principles of the study were presented to the pharmacists and they were invited to participate in a survey. This survey was divided into 6 topics with 26 questions. The topics were: advice on breastfeeding, pain and inflammation during breastfeeding, use of a breast pump, preservation and reheating of breast milk, breastfeeding and medication, breastfeeding and contraception, and breastfeeding promotion. The survey also evaluated their willingness to promote breastfeeding and the assistance needed for undertaking this promotion. By counting the right answers from 13 of the 26 questions, a global grade was calculated reflecting the knowledge of the participants. The maximum grade was 20 because many questions had several correct answers. RESULTS: Twenty-nine pharmacies agreed to participate (participation rate, 88%). The mean grade was 13.4 (95% CI: 12.7-14.0). Professional and personal experience had no influence on the grades. In the opinion of the pharmacists, the 3 topics most frequently raised by women were cracked nipples, mastitis, and painful breast (quoted by 83% of the pharmacists), the infant formula to use as a complete or partial substitute for breastfeeding (66%), and breastfeeding and medication (59%). Fifty-five percent of the participants were aware of the WHO recommendations on exclusive breastfeeding up to 6 months of age. The desire to promote breastfeeding was strong (68%). Thus, all pharmacists favored the distribution of a leaflet giving information on breastfeeding. CONCLUSION: This study shows a strong desire to promote breastfeeding among the pharmacists surveyed. It allows focusing on the themes that could be the target for continuing education, based on mothers' needs.