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2.
Int J Gynaecol Obstet ; 164 Suppl 1: 31-41, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38360034

RESUMO

In 2019, FIGO started implementing its abortion project focusing on advocacy. The Advocacy for Safe Abortion (ASA) Project was conducted in partnership with 10 national professional societies of obstetrics and gynecology in Latin America and Africa. The project aimed to strengthen national societies, support them to be leaders in sexual and reproductive health, and enable them to obtain context-specific advocacy goals that improve access to safe abortion. Innovative monitoring and evaluation methodology enabled tracking of outcomes, consideration of their contribution to success, and cross-country evaluation. The project saw success through some key strategies: institutional capacity strengthening; enhanced work through collaborations; training to increase knowledge and reduce abortion-related stigma with a broad array of stakeholders; and generation and use of evidence to influence decision-makers. This article describes the project and methodology used and provides tangible examples of how societies have been agents of change in their countries and of the need for such important work to continue.


Assuntos
Aborto Induzido , Ginecologia , Obstetrícia , Gravidez , Feminino , Humanos , América Latina , Saúde Reprodutiva , Sociedades Médicas , África
3.
J Interpers Violence ; 36(13-14): NP7415-NP7438, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-30735091

RESUMO

Intimate partner violence, nonpartner sexual violence, and physical and sexual violence against children are significant public health issues in South Africa. Theory suggests that experiencing violence in childhood plays a role in propensity to perpetrate violence or vulnerability to violence in adulthood. Most research to date on this topic has been conducted in high-resource countries or within urban or high-risk populations. We explore the relationship between violence in childhood and violence in adulthood in a community-based sample of 18- to 49-year-old adults in rural South Africa using data from a population-based survey (N = 1,044) in North West province in 2014. We measured childhood violence before age 15 years, experience of nonpartner sexual violence in adulthood, and IPV victimization and perpetration in the last 12 months. We conducted multivariate logistic regression; gender was tested as an effect modifier. All estimates are weighted to the subdistrict population. More women (2.7%) than men (0.8%) reported childhood forced sex, whereas fewer women (2.0%) than men (7.9%) reported childhood physical violence. Women and men reported similar rates of IPV victimization (6.8% vs. 5.4%), IPV perpetration (3.3% vs. 4.8%), and forced sex by a nonpartner (1.6% vs. 1.2%). We found that men and women who experienced childhood violence (combined physical and/or sexual) were significantly more likely to experience forced sex by a nonpartner (men: adjusted odds ratio [aOR] = 5.53, 95% confidence interval [CI] = [1.27, 24.0], p < .05; women: aOR = 51.1, 95% CI = [10.58, 246.3], p < .01) compared with those who did not experience childhood violence. They were also 2.5 times as likely to perpetrate recent IPV (aOR = 2.5, 95% CI = [0.97, 6.7], p = .06) or experience recent IPV (aOR = 2.5, 95% CI = [0.9, 6.9], p = .07), although this finding was marginally significant. These results align with the literature from other settings and population groups.


Assuntos
Violência por Parceiro Íntimo , Delitos Sexuais , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Abuso Físico , Prevalência , Fatores de Risco , Comportamento Sexual , Parceiros Sexuais , África do Sul , Adulto Jovem
4.
Int J Gynaecol Obstet ; 152(3): 386-394, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32981091

RESUMO

OBJECTIVE: To assess the effect of Helping Mothers Survive Bleeding after Birth training on postpartum hemorrhage (PPH) near miss and case fatality rates in Uganda. METHODS: Training was evaluated using a cluster-randomized design between June 2016 and September 2017 in 18 typical rural districts (clusters) in Eastern and Central Uganda of which nine districts were randomly assigned to the intervention. The main outcome was PPH near miss defined using the World Health Organization's disease and management-based approach. Interrupted time series analysis was performed to estimate the difference in the change of outcomes. RESULTS: Outcomes of 58 000 and 95 455 deliveries during the 6-month baseline and 10-month endline periods, respectively, were included. A reduction of PPH near misses was observed in the intervention compared to the comparison districts (difference-in-difference of slopes 4.19, 95% CI, -7.64 to -0.74); P<0.05). There was an increase in overall reported near miss cases (difference-in-difference 1.24, 95% CI, 0.37-2.10; P<0.001) and an increase in PPH case fatality rate (difference-in-difference 2.13, 95% CI, 0.14-4.12; P<0.05). CONCLUSION: This pragmatic cluster-randomized trial conducted in typical rural districts of Uganda indicated a reduction of severe PPH cases while case fatality did not improve, suggesting that this basic training needs to be complemented by additional measures for sustained mortality reduction. TRIAL REGISTRATION: PACTR201604001582128.


Assuntos
Capacitação em Serviço , Serviços de Saúde Materna , Near Miss , Avaliação de Resultados em Cuidados de Saúde , Hemorragia Pós-Parto/prevenção & controle , Cuidado Pré-Natal , Adulto , Feminino , Humanos , Análise de Séries Temporais Interrompida , Mortalidade Materna , Hemorragia Pós-Parto/mortalidade , Gravidez , Uganda
5.
Int J Gynaecol Obstet ; 147(3): 389-396, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31539164

RESUMO

OBJECTIVE: To assess the consistency of maternal near-miss incidence and mortality index between two definitions across 104 facilities in Tanzania and Uganda. METHODS: Based on WHO guidance, cross-sectional near-miss data were collected in Tanzania (July 2015 to October 2016) and Uganda (June 2016 to September 2017). Prepartum hemorrhage and abortion were included as additional screening events and the number of blood units transfused was recorded. Near-miss incidence and mortality index were determined by using two near-miss definitions: the WHO standard definition, and a modified definition including women receiving at least 1 unit of blood. A sensitivity analysis excluded the additional screening events. RESULTS: Near-miss incidence differed between Tanzania and Uganda (1.79 and 4.00, respectively, per 100 deliveries) when estimated by the standard definition, but was similar (5.24 and 4.94, respectively) by the modified definition. The mortality index was higher in Tanzania than in Uganda when estimated by the standard definition (8.56% vs 3.54%), but was similar by the modified definition (3.10% vs 2.89%). CONCLUSION: The modified definition provided a more consistent estimate of near-miss incidence and mortality index. Lowering the threshold for units of blood transfusion might improve comparability between settings, but more research is needed.


Assuntos
Near Miss/estatística & dados numéricos , Complicações do Trabalho de Parto/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Incidência , Mortalidade Materna , Pobreza , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Tanzânia/epidemiologia , Uganda/epidemiologia
6.
J Int AIDS Soc ; 22(6): e25295, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31190460

RESUMO

INTRODUCTION: To achieve epidemic control of HIV by 2030, countries aim to meet 90-90-90 targets to increase knowledge of HIV-positive status, initiation of antiretroviral therapy (ART) and viral suppression by 2020. We assessed the progress towards these targets from 2014 to 2016 in South Africa as expanded treatment policies were introduced using population-representative surveys. METHODS: Data were collected in January to March 2014 and August to November 2016 in Dr. Ruth Segomotsi Mompati District, North West Province. Each multi-stage cluster sample included 46 enumeration areas (EA), a target of 36 dwelling units (DU) per EA, and a single resident aged 18 to 49 per DU. Data collection included behavioural surveys, rapid HIV antibody testing and dried blood spot collection. We used weighted general linear regression to evaluate differences in the HIV care continuum over time. RESULTS: Overall, 1044 and 971 participants enrolled in 2014 and 2016 respectively with approximately 77% undergoing HIV testing. Despite increases in reported testing, known status among people living with HIV (PLHIV) remained similar at 68.7% (95% Confidence Interval (CI) = 60.9-75.6) in 2014 and 72.8% (95% CI = 63.6-80.4) in 2016. Men were consistently less likely than women to know their status. Among those with known status, PLHIV on ART increased significantly from 80.9% (95% CI = 71.9-87.4) to 91.5% (95% CI = 84.4-95.5). Viral suppression (<5000 copies/mL using DBS) among those on ART increased significantly from 55.0% (95% CI = 39.6-70.4) in 2014 to 81.4% (95% CI = 72.0-90.8) in 2016. Among all PLHIV an estimated 72.0% (95% CI = 63.8-80.1) of women and 45.8% (95% CI = 27.0-64.7) of men achieved viral suppression by 2016. CONCLUSIONS: Over a period during which fixed-dose combination was introduced, ART eligibility expanded, and efforts to streamline treatment were implemented, major improvements in the second and third 90-90-90 targets were achieved. Achieving the first 90 target will require targeted and improved testing models for men.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Adolescente , Adulto , Continuidade da Assistência ao Paciente , Epidemias , Feminino , HIV/genética , HIV/isolamento & purificação , HIV/fisiologia , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , África do Sul/epidemiologia , Adulto Jovem
7.
Int J Gynaecol Obstet ; 144(1): 37-48, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30289170

RESUMO

OBJECTIVE: To estimate the stillbirth risk associated with intrapartum adverse events, controlling for fetal and maternal factors. METHODS: The present study was an analysis of cross-sectional patient-record and facility-file data from women with viable fetuses who experienced obstetric adverse events at 23 hospitals and 38 health centers in Tanzania (between December 2015 and October 2016), and 22 hospitals, 16 level-4 health centers, and five level-3 health centers in Uganda (between May 2016 and September 2017). Adverse events were categorized in three severity groups (postpartum, intrapartum non-near-miss, and intrapartum near-miss) to calculate stillbirth rates and adjusted prevalence ratios. RESULTS: Data from 3816 women in Tanzania and 8305 in Uganda were included. Compared with postpartum adverse events, intrapartum near-miss was associated with a 3.73- and 4.55-fold higher prevalence of stillbirth in Uganda and Tanzania, respectively. Most women who experienced near-miss had organ dysfunction on arrival or developed it soon after. The risk of stillbirth was higher among preterm deliveries compared with term deliveries, and was 42% and 59% lower in Tanzania and Uganda, respectively, for cesarean deliveries compared with vaginal deliveries after intrapartum non-near-miss adverse events. CONCLUSION: Stillbirth risk increased with severity of complications and was higher among premature deliveries. Survival was higher for cesarean deliveries in intrapartum non-near-miss complications, identifying the opportunity to prevent deterioration by timely actions.


Assuntos
Complicações na Gravidez , Natimorto/epidemiologia , Adulto , Cesárea/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Near Miss/estatística & dados numéricos , Gravidez , Prevalência , Fatores de Risco , Tanzânia/epidemiologia , Uganda/epidemiologia , Adulto Jovem
8.
Int J Gynaecol Obstet ; 144(1): 122-127, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30387124

RESUMO

OBJECTIVE: To establish whether national guidelines for postpartum hemorrhage (PPH) reflect new scientific evidence on misoprostol, and determine the challenges faced in their implementation. METHODS: A web-based survey was sent by email to 130 national societies of obstetrics and gynecology (FIGO Member Associations) in 2016. The survey, composed of 18 questions, covered national guidelines on PPH with particular reference to misoprostol, the creation of national guidelines, and challenges to implementation. RESULTS: Completed surveys were received from 69 societies, for a 53% response rate. The key findings were that many countries lacked comprehensive, up-to-date, evidence-based national guidelines providing guidance on misoprostol use; recommended regimens were very different in the national guidelines as well as between international and regional guidelines that are most often used as referencing documents; and there are a variety of challenges to implementation of guidelines. CONCLUSION: There is a need, especially in countries with high maternal mortality, to establish mechanisms that ensure the existence of up-to-date, comprehensive, evidence-based guidelines on PPH. This can be difficult given conflicting guidance at the international level. Regional and international societies should prioritize clinical updates and ensure their dissemination and implementation.


Assuntos
Misoprostol/administração & dosagem , Ocitócicos/administração & dosagem , Hemorragia Pós-Parto/prevenção & controle , Guias de Prática Clínica como Assunto , Atenção à Saúde , Feminino , Saúde Global , Humanos , Gravidez , Inquéritos e Questionários
9.
AIDS Care ; 30(3): 330-337, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28814110

RESUMO

Antiretroviral therapy (ART) could curtail the HIV epidemic, but its impact is diminished by low uptake. We developed a peer navigation program to enhance engagement in HIV care, ART adherence, and behavioral prevention. In preparation for a randomized controlled trial, the program was piloted over four months at two primary health clinics in South Africa's North West Province. Newly diagnosed, HIV-positive clients met regularly with navigators to address barriers to care, adherence, and prevention. To assess program acceptability and feasibility and characterize the mechanisms of action, we surveyed 25 clients who completed navigation services and conducted interviews with 10 clients, four navigators, and five clinic providers. Clients expressed near universal approval for the program and were satisfied with the frequency of contact with navigators. HIV stigma emerged as a primary driver of barriers to care. Navigators helped clients overcome feelings of shame through education and by modeling how to live successfully with HIV. They addressed discrimination fears by helping clients disclose to trusted individuals. These actions, in turn, facilitated clients' care engagement, ART adherence, and HIV prevention efforts. The findings suggest peer navigation is a feasible approach with potential to maximize the impact of ART-based HIV treatment and prevention strategies.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Navegação de Pacientes/métodos , Grupo Associado , Estigma Social , Instituições de Assistência Ambulatorial , Antirretrovirais/administração & dosagem , Aconselhamento , Estudos de Viabilidade , Feminino , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Projetos Piloto , África do Sul
13.
Int J Gynaecol Obstet ; 131 Suppl 1: S40-2, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26433504

RESUMO

Adolescent sexual and reproductive health (ASRH) has been overlooked historically despite the high risks that countries face for its neglect. Some of the challenges faced by adolescents across the world include early pregnancy and parenthood, difficulties accessing contraception and safe abortion, and high rates of HIV and sexually transmitted infections. Various political, economic, and sociocultural factors restrict the delivery of information and services; healthcare workers often act as a barrier to care by failing to provide young people with supportive, nonjudgmental, youth-appropriate services. FIGO has been working with partners and its member associations to break some of these barriers-enabling obstetricians and gynecologists to effect change in their countries and promote the ASRH agenda on a global scale.


Assuntos
Saúde Global/tendências , Acessibilidade aos Serviços de Saúde/tendências , Serviços de Saúde Materna/tendências , Saúde Reprodutiva/tendências , Saúde da Mulher/tendências , Aborto Induzido/psicologia , Aborto Induzido/tendências , Adolescente , Comportamento Contraceptivo/psicologia , Comportamento Contraceptivo/tendências , Feminino , Humanos , Gravidez , Gravidez na Adolescência/prevenção & controle , Gravidez na Adolescência/psicologia , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/psicologia
16.
Afr J Reprod Health ; 18(3): 101-17, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25438515

RESUMO

Contextualising maternal health in countries with high maternal mortality is vital for designing and implementing effective health interventions. A research project was therefore conducted to explore practices, beliefs and traditions around pregnancy, delivery and postpartum in southeast Madagascar. Interviews and focus groups were conducted with 256 pregnant women, mothers of young children, community members and stakeholders; transcripts were analysed to identify and explore predetermined and emerging themes. A questionnaire was also conducted with 373 women of reproductive age from randomly selected households. Data was analysed using STATA. Results confirmed high local rates of maternal mortality and morbidity and revealed a range of traditional health care practices and beliefs impacting on women's health seeking behaviours. The following socio-cultural barriers to health were identified: 1) lack of knowledge, 2) risky practices, 3) delays seeking biomedical care, and 4) family and community expectations. Recommendations include educational outreach and behaviour change communications targeted for women, their partners and family, increased engagement with traditional midwives and healers, and capacity building of formal health service providers.


Assuntos
Cultura , Complicações do Trabalho de Parto , Aceitação pelo Paciente de Cuidados de Saúde , Assistência Perinatal , Adolescente , Adulto , Pesquisa Participativa Baseada na Comunidade , Feminino , Grupos Focais , Letramento em Saúde , Humanos , Madagáscar/epidemiologia , Mortalidade Materna , Pessoa de Meia-Idade , Avaliação das Necessidades , Complicações do Trabalho de Parto/classificação , Complicações do Trabalho de Parto/prevenção & controle , Complicações do Trabalho de Parto/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Preferência do Paciente , Assistência Perinatal/métodos , Assistência Perinatal/normas , Gravidez , Pesquisa Qualitativa , Percepção Social
17.
AIDS Patient Care STDS ; 28(9): 499-506, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25133501

RESUMO

A self-administered, street intercept survey was conducted in order to examine the relation of stigma and shame associated with sexually transmitted infections (STI) to STI testing practices, partner notification, and partner-delivered treatment among young African American men (n=108) in a low-income, urban community in San Francisco with high STI burden. Multivariate logistic regression revealed that increasing STI-related stigma was significantly associated with a decreased odds of STI testing, such that every standard deviation increase in stigma score was associated with 0.62 decreased odds of having been tested (aOR: 0.62, 95% CI: 0.38-1.00), controlling for age. STI stigma was also significantly associated with a decreased willingness to notify non-main partners of an STI (aOR: 0.64 95% CI: 0.41-0.99). Participants with higher levels of stigma and shame were also significantly less likely to be willing to deliver STI medication to a partner (stigma aOR: 0.57, 95% CI: 0.37-0.88; shame aOR 0.53 95% CI: 0.34-0.83). Findings suggest that STI-related stigma and shame, common in this population, could undermine STI testing, treatment, and partner notification programs. The medical establishment, one of the institutional factors to have reinforced this culture of stigma, must aid efforts to reduce its effects through providing integrated services, reframing sexual health in campaigns, educating clients, and providing wider options to aid disclosure and partner notification practices.


Assuntos
Negro ou Afro-Americano/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/etnologia , Vergonha , Estigma Social , Adolescente , Negro ou Afro-Americano/estatística & dados numéricos , Busca de Comunicante , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Áreas de Pobreza , São Francisco/epidemiologia , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/prevenção & controle , Fatores Socioeconômicos , População Urbana , Adulto Jovem
18.
MCN Am J Matern Child Nurs ; 37(5): 308-16, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22895203

RESUMO

PURPOSE: To discuss the role of nurses and nurse-midwives in preventing and treating postpartum hemorrhage (PPH) from uterine atony in developing countries and examine the role of a new device, the non-pneumatic anti-shock garment (NASG), in improving the outcomes for these patients. STUDY DESIGN AND METHODS: In this subanalysis of a larger preintervention phase/intervention phase study of 1,442 women with obstetric hemorrhage, postpartum women with hypovolemic shock (N = 578) from uterine atony (≥750 mL blood loss; systolic blood pressure <100 mmHg and/or pulse >100 beats per minute) were enrolled in two referral facilities in Egypt and four referral facilities in Nigeria. The study had two temporal phases: a preintervention phase and an NASG-intervention phase. Women with hemorrhage and shock in both phases were treated with the same evidence-based protocols for management of hypovolemic shock and hemorrhage, but women in the NASG-intervention phase also received the NASG. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated for primary outcomes-measured blood loss, incidence of emergency hysterectomy, and mortality. RESULTS: Women in the NASG-intervention phase had significantly better outcomes, 50% lower blood loss, reduced rates of hysterectomy (8.9% vs. 4%), and mortality decreased from 8.5% to 2.3% (RR = 0.27, 95% CI: 0.12-0.60). CLINICAL IMPLICATIONS: In low-resource settings nurses have few resources with which to stabilize women with severe PPH. With training nurses and nurse-midwives can stabilize hemorrhaging women with the NASG, a low-technology first-aid device that shows promise for reducing blood loss, rates of hysterectomy, and mortality.


Assuntos
Mortalidade Materna , Hemorragia Pós-Parto/prevenção & controle , Complicações Cardiovasculares na Gravidez/prevenção & controle , Choque/prevenção & controle , Inércia Uterina/prevenção & controle , Adulto , Países em Desenvolvimento , Egito , Feminino , Primeiros Socorros/instrumentação , Primeiros Socorros/métodos , Trajes Gravitacionais , Humanos , Histerectomia , Nigéria , Hemorragia Pós-Parto/mortalidade , Pobreza , Gravidez , Complicações Cardiovasculares na Gravidez/mortalidade , Resultado da Gravidez , Choque/mortalidade , Inércia Uterina/mortalidade
19.
Matern Child Health J ; 16(7): 1355-63, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22045020

RESUMO

The role of prenatal depression on physical and mental health among women in mainland China has not been previously investigated. The aim of this research was to (a) calculate the prevalence of depression during pregnancy, (b) explore the relationship between depression sample characteristics and quality of life and (c) identify predictors of physical and mental health among pregnant women. This study was designed as a cross-sectional and exploratory survey. A total of 454 pregnant women participated in the study between December 2009 and June 2010 in central China. The data was collected using the Medical Outcomes Study short form 36 v2 and the Edinburgh Postnatal Depression Scale. Participants were recruited at outpatient departments of obstetrics and gynecology. Findings show that almost 40% of pregnant women experience prenatal depression. Depression was significantly associated with physical and mental health-related quality of life (HRQoL). Depression, increased age, higher gestational age, being employed and married were significant predictors of lower physical HRQoL. Depression, lower BMI and having an unintended pregnancy were significant predictors of lower mental HRQoL. Prenatal depression is very common in women from mainland China. Depressed women suffer from impaired physical and mental health; prenatal depression has a negative impact on women's HRQoL. We recommend that antenatal services integrate screening for depression into routine antenatal care.


Assuntos
Depressão/psicologia , Nível de Saúde , Complicações na Gravidez/psicologia , Qualidade de Vida , Adulto , Índice de Massa Corporal , China/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Saúde Mental , Gravidez , Complicações na Gravidez/epidemiologia , Trimestres da Gravidez , Cuidado Pré-Natal , Prevalência , Escalas de Graduação Psiquiátrica , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
20.
Artigo em Inglês | MEDLINE | ID: mdl-21822444

RESUMO

Objective. To explore evidence for the traditional Tibetan medicine, Zhi Byed 11 (ZB11), for use as a uterotonic. Methods. The eleven ingredients in ZB11 were chemically analyzed by mass spectroscopy. A review was conducted of Western allopathic literature for scientific studies on ZB11's individual components. Literature from Tibetan and other traditional paradigms were reviewed. Results. Potential mechanisms of action for ZB11 as a uterotonic include laxative effects, a dose-dependant increase in smooth muscle tissue peristalsis that may also affect the uterus smooth muscle, and chemical components that are prostaglandin precursors and/or increase prostaglandin synthesis. A recent RCT demonstrated comparable efficacy to misoprostol in reducing severe postpartum hemorrhage (PPH) (>1000 mL) and greater effect than placebo. Historical and anecdotal evidence for ZB11 and its ingredients for childbirth provide further support. Discussion. ZB11 and its ingredients are candidates for potentially effective uterotonics, especially in low-resource settings. Further research is warranted to understand the mechanisms of action and synergy between ingredients.

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