Effect of the Confidential Enquiries into Maternal Deaths on the use of Syntocinon® at Caesarean section in the UK*

Abstract

Summary The recommended dose of Syntocinon® used for uterine contraction at Caesarean section is 5 units intravenously, given slowly. We conducted a survey of the use of Syntocinon at Caesarean section among 240 lead obstetric anaesthetists in the UK in 2001 and found that 155 (87%) of the 179 (75%) respondents gave 10 units, 77 of them (50%) by rapid bolus. The risks of Syntocinon, especially given by rapid injection, were highlighted in the report of the Confidential Enquiries into Maternal Deaths in the UK (1997–99), which was published at the end of 2001, and so the survey was repeated in 2002. Of the 256 forms sent, 198 completed replies were returned (77%); these indicated a dramatic change of practice: only 30 (15%) now gave 10 units and only 7 of these (23%) by a rapid injection. One hundred and sixty‐seven respondents to the second survey (84%) stated they had changed their practice and 159 of these (95%) gave the Confidential Enquiries report as the main reason for change. These results highlight the importance of the Confidential Enquiries as a means of improving practice.

ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

“…Excessive blood loss is more likely during intrapartum caesareans and oxytocin could be detrimental to women who are hypovolemic. 11,15,[17][18][19] It is reasonable to assume that ST-depressions are as common during intrapartum caesareans and the clinical significance of our results could be more important within such circumstances.…”

“…In Britain as in Sweden, an intravenous bolus is common while in the United States, an infusion is practice. 15,16 Furthermore, doses of oxytocin given during caesarean delivery appear to be empirical and extrapolated from studies on vaginal delivery, in which oxytocic drugs used routinely appear to reduce the risk of postpartum haemorrhage by about 40%. [29][30][31] A slow intravenous bolus dose of 5 units of oxytocin following delivery of the infant is currently recommended to decrease blood loss.…”

“…[12][13][14] Doses of oxytocin, as well as route of administration, vary widely in clinical practice and many clinicians are not aware of all the adverse effects of oxytocin. 15,16 Oxytocin could be detrimental to women who are hypovolemic and to women with cardiac disease. 11,15,[17][18][19] As oxytocin has dose-dependent adverse effects, we were interested in finding out whether there are any differences in the rate of ECG changes indicating myocardial ischaemia (ECG depression) between two different doses of oxytocin.…”

“…15,16 Oxytocin could be detrimental to women who are hypovolemic and to women with cardiac disease. 11,15,[17][18][19] As oxytocin has dose-dependent adverse effects, we were interested in finding out whether there are any differences in the rate of ECG changes indicating myocardial ischaemia (ECG depression) between two different doses of oxytocin.…”

Ocitocina em cesarianas: qual a Melhor Maneira de Utilizá-la?

“…Bolton 87% dos anestesiologistas consultados utilizavam 10 UI de ocitocina em bolus, tanto em cesarianas eletivas quanto em situações de hemorragia pós-parto. Após a publicação de relatos de óbito materno advindo da utilização inadequada da ocitocina 38 , os autores observaram uma mudança na conduta clínica desses anestesiologistas, já que a partir de então apenas 23% mantinham a conduta anterior 41 . Em relação à via de administração, apesar da via intramiometral promover contratilidade uterina eficiente como a via venosa, ela determina maiores alterações hemodinâ-micas (hipotensão arterial e taquicardia) o que pode ser prejudicial em pacientes com baixa reserva cardíaca ou hipovolêmicas 42 .…”