Key takeaways:
1. A Caesarean section, or C-section, is a surgery used to deliver a baby through cuts made in the mother’s abdomen and uterus. It is often done when a normal vaginal delivery may be risky for the mother or baby. In many cases, C-sections are life-saving procedures. However, like all surgeries, they can sometimes lead to complications.
2. C-section complications can happen during the surgery, immediately after delivery, or even weeks later. Some complications are mild and manageable, while others can become serious if not treated quickly.
3. One of the most common complications is infection. Infection may occur at the surgical wound, inside the uterus, or in nearby organs such as the bladder. Women with infection may develop fever, pain, redness around the stitches, swelling or foul-smelling discharge.
4. Heavy bleeding, also called postpartum hemorrhage, is another major risk. Since a C-section is a surgery, blood loss is generally higher than in a vaginal delivery. In some cases, bleeding becomes severe enough that the mother may need a blood transfusion or emergency treatment.
5. Complications related to anesthesia can also occur. During a C-section, women are usually given spinal, epidural or general anesthesia. Some patients may experience allergic reactions, breathing problems, low blood pressure, severe headache, or nausea due to these medicines.
How are fake medicines creating complications and maternal death?
1. In Kota, the initial investigation suggested that fatalities were linked to the use of fake or substandard oxytocin — a critical drug used to induce labour before a delivery and to contract the uterus to prevent blood loss after it. Many of the women who died or developed complications in Rajasthan experienced excessive blood loss. Tests indicated the drug lacked active pharmaceutical ingredients.
2. Oxytocin is naturally secreted by the pituitary glands of mammals during sex, childbirth, lactation or social bonding, and is sometimes called “love hormone”. However, it can also be chemically manufactured and is sold by pharma companies for use during childbirth. It is administered either as an injection or a nasal solution.
3. During a normal vaginal birth, the body releases significant amounts of natural oxytocin in response to labour. However, during a C-section, especially under spinal or epidural anaesthesia, this natural hormonal response may not be sufficient.
4. It is a practice to give oxytocin during a C-section contraction to help the uterus contract strongly and consistently. These contractions are essential to reduce bleeding after childbirth and prevent postpartum haemorrhage, one of the leading causes of maternal mortality worldwide.
5. Oxytocin also stimulates breast milk production and aids in the separation and expulsion of the placenta, reducing the risk of complications after surgery.
6. Dr Richa Bharadwaj, consultant obstetrician and gynaecologist, Wockhardt Hospitals, Mumbai Central said that a simple way to understand its role is to think of the uterus as a natural pressure bandage. She said that after delivery, the blood vessels where the placenta was attached remain open.
7. “Oxytocin causes the uterine muscles to tighten around these vessels, effectively reducing blood flow and preventing excessive bleeding. If the uterus remains relaxed or fails to contract adequately, blood loss can become rapid and severe, requiring emergency interventions, blood transfusions, or intensive care support,” said Dr Bharadwaj.
BEYOND THE NUGGET: Central Drugs Standard Control Organisation (CDSCO)
1. In the first week of June, the Central Drugs Standard Control Organisation (CDSCO) held a joint inspection of the manufacturing units in Punjab and Himachal of Jackson Laboratories, the manufacturer of the oxytocin that is under a cloud in Rajasthan, along with the regulators of the two states.
2. The Drugs & Cosmetics Act,1940 and rules 1945 have entrusted various responsibilities to central and state regulators for regulation of drugs & cosmetics. CDSCO under Directorate General of Health Services, Ministry of Health & Family Welfare, is the National Regulatory Authority (NRA) of India.
3. Under the Drugs and Cosmetics Act, CDSCO is responsible for approval of Drugs, Conduct of Clinical Trials, laying down the standards for Drugs, control over the quality of imported Drugs in the country, and coordination of the activities of State Drug Control Organizations by providing expert advice with a view to bringing about uniformity in the enforcement of the Drugs and Cosmetics Act.
4. Recently, the Center has imposed an immediate ban on 16 Fixed Dose Combination (FDC) drugs. The Ministry of Health and Family Welfare issued the orders under Section 26A of the Drugs and Cosmetics Act, effectively halting the manufacture, sale and distribution of these medicines across India.
5. This move branches from a Supreme Court-mandated review of the Indian drug market. Following the court’s orders, the Drugs Technical Advisory Board (DTAB) of CDSCO formed an expert committee to completely remove potentially harmful formulations.
Post Read Question
Consider the following statements about Oxytocin:
1. Released by the gonads.
2. Also called the love hormone.
3. Aids in the separation and expulsion of the placenta.
Which of the statements given above is/are correct?
(a) 1 only
(b) 1 and 2 only
(c) 2 and 3 only
(d) 1, 2, and 3
Answer Key
(c)
(Sources: Kota C-section death raises questions: How safe are Caesarean deliveries and what complications can occur?, Why oxytocin is vital in C-sections, and how fake doses can kill, Explained: What is Oxytocin and why does the govt want to ban its commercial use?)
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In Kota, investigation suggested that fatalities were linked to the use of fake or substandard oxytocin during child birth. (AI generated) 
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