Use of oxytocin to prevent haemorrhage at caesarean section--a survey of practice in the United Kingdom.
OBJECTIVE
To establish the views and current practice of obstetricians and anaesthetists with regard to the use of oxytocin to prevent haemorrhage at caesarean section.


METHODS
A national survey of all lead consultant obstetricians and anaesthetists for the labour ward in the United Kingdom. A postal questionnaire was sent to all clinicians with one subsequent reminder to non-responders. The use of oxytocin bolus and infusion, perceived side effects of intravenous oxytocin, estimated blood loss at caesarean section, and willingness to participate in a future clinical trial were explored.


RESULTS
The response rate was 84% (365 respondents). A slow bolus of 5 IU oxytocin was the preferred approach of obstetricians and anaesthetists (153, 86% and 171, 92%, respectively). Oxytocin infusions were used routinely by 72 clinicians (20%) with selective use for particular clinical circumstances by 289 (80%). Most clinicians used either 30 IU (158, 43%) or 40 IU (192, 53%) infusions over 4h, with a total of 38 different regimens. The perceived risk of side effects with an oxytocin infusion was low. Estimated "average" blood loss varied (150-1,500 ml) with 56 clinicians (17%) and 93 (28%) reporting a >20% risk of postpartum haemorrhage for elective and emergency caesarean sections, respectively.


CONCLUSIONS
There is wide variation in the use of oxytocin at caesarean section reflecting limited research in this area. Excess haemorrhage is considered to occur frequently and the perceived risk of oxytocin bolus and infusion is low. Further research is required addressing the optimal use of oxytocic agents at caesarean section.
Wedisinghe
Lilantha
L
Department of Obstetrics & Gynaecology, Ninewells Hospital & Medical School, Dundee DD1 9SY, United Kingdom.
Macleod
Maureen
M
Murphy
Deirdre J
DJ
D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002585:Cesarean Section / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010121:Oxytocin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D006113:United Kingdom
D010120:Oxytocics; D010121:Oxytocin