title: Uterotonics for Non-emergent Caesarean Section: Protocol Change During UK-Licensed Drug Shortage.
abstract: The aim was to assess the efficacy of Syntometrine®(500 micrograms ergometrine with 5 units oxytocin) as an appropriate alternative first-line uterotonic for use in elective caesarean section (CS) during a national shortage of UK-licensed IV oxytocin from April-June 2014. An observational study was performed involving 2 groups of 22 women undergoing elective CS in a UK DGH during this period. Primary endpoints included mean estimated blood loss (EBL), haemoglobin drop post-operatively and transfusion requirement. Secondary endpoints were use of antiemetics and mean post-operative nausea and vomiting (PONV) score. Results for Syntometrine®groups and syntocinon groups respectively: mean EBL (ml) 527.3 vs. 550.0 (p=0.5820), mean haemoglobin drop (g/dL) 0.977 vs. 0.982 (p=0.98), blood transfusion 1/22 vs. 0/22 (p=1). Intra-operative antiemetics 20/22 vs. 6/22 (p=<0.001), post-operative antiemetics 2/22 vs. 2/22 (p=1), mean PONV score 11.5 vs. 3.5 (p=0.099). As no significant difference in primary endpoints or PONV scores was observed between regimes, we conclude Syntometrine®was a safe first-line haemostatic agent for elective CS during oxytocin shortage.
authors.affiliation: Department of Obstetrics and Gynaecology, Craigavon Area Hospital, Southern Health and Social Care Trust, Northern Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Malone
authors.affiliation: Department of Obstetrics and Gynaecology, Daisy Hill Hospital, Southern Health and Social Care Trust, Northern Ireland.
authors.forename: J R
authors.initials: JR
authors.lastname: Acheson
authors.affiliation: Department of Anaesthetics, Craigavon Area Hospital, Southern Health and Social Care Trust, Northern Ireland.
authors.forename: J D
authors.initials: JD
authors.lastname: Hinds
authors.affiliation: Department of Obstetrics and Gynaecology, Craigavon Area Hospital, Southern Health and Social Care Trust, Northern Ireland.
authors.forename: M H
authors.initials: MH
authors.lastname: McComiskey
mesh_terms: D002585:Cesarean Section / Q000379:methods*; D017558:Elective Surgical Procedures; D004874:Ergonovine / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010120:Oxytocics / Q000494:pharmacology; D010121:Oxytocin / Q000494:pharmacology*; D011247:Pregnancy; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D006113:United Kingdom
chemical_list: D010120:Oxytocics; C038346:syntometrine; D010121:Oxytocin; D004874:Ergonovine
keywords: Drug shortages; patient safety; post-operative nausea and vomiting; postpartum haemorrhage; uterotonic