Prophylactic administration of uterotonics ensures adequate uterine contraction at elective caesarean section to prevent substantial haemorrhage. Royal College of Obstetricians and Gynaecologists guidelines advise the administration of oxytocin 5 IU as a 'slow bolus' but there are variations in clinical practice. This study aimed to determine the beliefs and uterotonic usage practices at elective caesarean section by surveying anaesthetist members of the Obstetric Anaesthesia Special Interest Group in Australia and New Zealand. Questionnaires were emailed to Obstetric Anaesthesia Special Interest Group members and the response rate was 33%, with analysis of 279 completed reports. Oxytocin was the most commonly used first-line uterotonic, but extensive variation in oxytocin bolus use was identified. Thirty-eight percent of anaesthetists routinely administered Royal College of Obstetricians and Gynaecologists guideline-recommended 5 IU, whereas 38% favoured low dose (<5 IU), 10% high dose (≥10 IU) oxytocin, and 13% carbetocin (100 µg). More than 50% felt the evidence was weak for guideline-recommended 5 IU. Wide variation in the duration of oxytocin administration was also identified. Fifty-eight percent of anaesthetists routinely gave follow-up oxytocin infusions, most commonly at 40 IU over four hours, but there was significant variation in the dosage (10-40 IU) and administration duration (one hour to ≥six hours). In conclusion, there is significant variation in oxytocin usage practices at elective caesarean section among Australian and New Zealand anaesthetists. This variation may be due to a lack of strong evidence to guide practice. This emphasises the need for high quality trials in this clinically important area.

Item Type:	Refereed Article
Keywords:	anesthesia, clinical practice, education, Caesarean section, oxytocin, postpartum haemorrhage
Research Division:	Biomedical and Clinical Sciences
Research Group:	Clinical sciences
Research Field:	Anaesthesiology
Objective Division:	Health
Objective Group:	Evaluation of health and support services
Objective Field:	Health education and promotion
UTAS Author:	Terblanche, NCS (Dr Nico Terblanche)
UTAS Author:	Otahal, P (Mr Petr Otahal)
UTAS Author:	Sharman, JE (Professor James Sharman)
ID Code:	147293
Year Published:	2021
Funding Support:	National Health and Medical Research Council (1045373)
Deposited By:	Menzies Institute for Medical Research
Deposited On:	2021-10-25
Last Modified:	2021-11-04
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