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Terblanche NC, Otahal P, Sharman JE. A survey of anaesthetists on uterotonic usage practices for elective caesarean section in Australia and New Zealand. Anaesth Intensive Care. 2021;49(6):440-447doi: 10.1177/0310057X211002838.
Terblanche, N. C., Otahal, P., & Sharman, J. E. (2021). A survey of anaesthetists on uterotonic usage practices for elective caesarean section in Australia and New Zealand. Anaesthesia and intensive care, 49(6), 440-447. https://doi.org/10.1177/0310057X211002838
Terblanche, Nico Cs, et al. "A survey of anaesthetists on uterotonic usage practices for elective caesarean section in Australia and New Zealand." Anaesthesia and intensive care vol. 49,6 (2021): 440-447. doi: https://doi.org/10.1177/0310057X211002838
Terblanche NC, Otahal P, Sharman JE. A survey of anaesthetists on uterotonic usage practices for elective caesarean section in Australia and New Zealand. Anaesth Intensive Care. 2021 Nov;49(6):440-447. doi: 10.1177/0310057X211002838. Epub 2021 Oct 17. PMID: 34657486.
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Anaesth Intensive Care. 2021 Nov;49(6):440-447. doi: 10.1177/0310057X211002838. Epub 2021 Oct 17.

A survey of anaesthetists on uterotonic usage practices for elective caesarean section in Australia and New Zealand.

Anaesthesia and intensive care

Nico Cs Terblanche, Petr Otahal, James E Sharman

Affiliations

  1. Department of Anaesthesia and Perioperative Medicine, Royal Hobart Hospital, Hobart, Australia.
  2. Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.

PMID: 34657486 DOI: 10.1177/0310057X211002838

Abstract

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 at 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 per cent 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 per cent of anaesthetists routinely gave follow-up oxytocin infusions, most commonly at 40 IU over 4 hours, but there was significant variation in the dosage (10-40 IU) and administration duration (1 hour to ≥6 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.

Keywords: Caesarean section; oxytocin; postpartum haemorrhage

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