Traditional preparations used as uterotonics in Sub-Saharan Africa and their pharmacologic effects

Background: Little is known about the use of traditional preparations for uterotonic effects at or near delivery in Sub-Saharan Africa. Objective: To describe (1) use of traditional preparations in Sub-Saharan Africa intended to have uterotonic effects at or near birth; and (2) results of pharmacologic investigations of the uterotonic properties of such preparations. Search strategy: Structured review of 13 databases. Selection criteria: Articles describing use of traditional preparations in Sub-Saharan Africa with primary data, published in English between January 1, 1980 and June 30, 2010. Data collection and analysis: Full-text review using standard spreadsheet templates. Main results: Objective 1 analysis identified 208 plant species used for uterotonic effects at or near delivery. The most common use was labor induction/augmentation (n = 185). Other uses were to expel the placenta, shorten the third stage of labor, manage retained placenta (n = 61), and prevent/manage postpartum hemorrhage (n = 20). Objective 2 analysis identified 82 species with uterotonic activity confirmed through pharmacologic evaluation. Studies also identified potentiating/inhibiting effects of extracts on pharmaceutical uterotonics. Conclusion: Numerous plants are used for uterotonic effects in Sub-Saharan Africa; uterotonic activity has been confirmed in many through pharmacologic evaluation. Such use may increase the risk of adverse outcomes. Further research is needed on the uterotonic efficacy of traditional preparations and on interventions to address use during labor.