Use of oxytocin to prevent haemorrhage at caesarean section—A survey of practice in the United Kingdom

Abstract 

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.

Study design

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 5IU 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 30IU (158, 43%) or 40IU (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 (150–1500ml) with 56 clinicians (17%) and 93 (28%) reporting a >20% risk of postpartum haemorrhage for elective and emergency caesarean sections, respectively.

Conclusion

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.

Keywords: Oxytocin, Caesarean section, Blood loss, Obstetric haemorrhage, Survey