A National Survey of Oxytocin Use during Caesarean Section in Zimbabwe

ABSTRACT

Background: Post-partum haemorrhage is the leading cause of mortality for labouring women in Zimbabwe. Current literature supports the use of low dose oxytocin to prevent bleeding during Caesarean section. Internationally; clinical practice has been slow to change and the use of potentially harmful; higher than recommended dose is common.Objective: To describe the current clinical practice in Zimbabwe.Design: A self-administered questionnaire survey. Descriptive statistics were used to report the study results.Setting: In 2013 a national survey was conducted on the use of oxytocin by different types of clinicians; who provide either anaesthesia or surgery for Caesarean section.Results: Of a total of 221 (61%) questionnaires returned; 170 (80%) were completed fully. Only 23% of respondents would give an intravenous dose of 5.0 IU or less of oxytocin for elective Caesarean section. The majority of clinicians (77%) would administer more than 5.0 IU of oxytocin at elective. A significant number of nurse anaesthetists 16/59 (27%); and a non-negligible number of specialist anaesthetists 3/48 (6%) would even give 20 IU of oxytocin in elective cases rising to 30% and 13% respectively for emergency cases. In case of persistent bleeding due to uterine atony; oxytocin was more likely to be repeated (45%); rather than using misoprostol (25%) or ergometrine (19%). Conclusion: Most clinicians in Zimbabwe use oxytocin doses well above current internationally recommended. This illustrates the urgent need for updated national guidelines for the prevention of post-partum haemorrhage during Caesarean section