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Objective To describe intrapartum uterotonic drug use and related behaviors in public health facility-based deliveries and to describe drug storage conditions in associated pharmacies. Methods A descriptive study was conducted between August and November 2011 to document practices related to uterotonic administration and storage based on direct observation of deliveries at public health facilities in four Indian districts (n = 97, n = 89, n = 91, and n = 89) with contrasting maternal health and socioeconomic indicators. Results Uterotonic drug use before and after delivery was common among the 366 study participants. Labor augmentation rates ranged from 53.5%–93.0% of deliveries across districts, with many receiving multiple uterotonics and administration via intramuscular injection or intravenous push. Uterotonic use following delivery ranged from 78.6%–99.1% across districts, with correct use of uterotonics for postpartum hemorrhage prevention varying from 6.0%–8.8% in Uttar Pradesh and 41.2%–76.4% in Karnataka. Active management of the third stage of labor following Indian guidelines was less than 10% in all districts. Storage of uterotonics at room temperature was common. Conclusion Given that labor augmentation is nearly routine and at odds with Indian guideline recommendations, rigorous research is needed to assess maternal and fetal outcomes of current versus guidelines-based practice. Active management of the third stage of labor as per Indian guidelines was minimal. [ABSTRACT FROM AUTHOR]

Context Vitamin D deficiency is common in urban Indians despite living in the tropics and its public health consequences are enormous. However, 70% of India is rural, and data from rural subjects, who are expected to have good sun exposure, are scant. Objectives To determine the population prevalence of vitamin D deficiency in rural pregnant women and adolescent girls, compare serum 25-hydroxyvitamin D (25OHD) status in adolescent boys from the same families, and determine seasonal differences in serum 25OHD. Design A cross-sectional study conducted over 18 months. Subjects A random selection of 121 adolescent girls from a survey of a population of 8270 in a rural low socioeconomic community; 139 pregnant women in the second trimester; and a subset of 28 adolescent girls compared with 34 brothers. Measurements Serum 25OHD, serum alkaline phosphatase (AP), sun exposure, and dietary calcium intake. Results The age-adjusted community prevalence of vitamin D deficiency (25OHD < 50 nmol/l) in adolescent girls was 88·6%. Seventy-four per cent of pregnant women had vitamin D deficiency. Mean ± SD 25OHD in girls and women in summer was 55·5 ± 19·8 nmol/l compared to 27·3 ± 12·3 nmol/l in winter ( P < 0·001). Winter serum 25OHD in boys (67·5 ± 29·0 nmol/l) was higher than that in their sisters (31·3 ± 13·5 nmol/l, P < 0·001). Conclusion We report a high prevalence of vitamin D deficiency among pregnant women and adolescent girls from a rural Indian community. Boys are relatively protected. Seasonal variation in serum 25OHD is significant at latitude 26° N. [ABSTRACT FROM AUTHOR]