Implementation of guidelines on oxytocin use at caesarean section: a survey of practice in Great Britain and Ireland.

Hdl Handle:
http://hdl.handle.net/10147/208036
Title:
Implementation of guidelines on oxytocin use at caesarean section: a survey of practice in Great Britain and Ireland.
Authors:
Sheehan, Sharon R; Wedisinghe, Lilantha; Macleod, Maureen; Murphy, Deirdre J
Affiliation:
Academic Department of Obstetrics & Gynaecology, Coombe Women and Infants, University Hospital & Trinity College, University of Dublin, Dublin 8, Ireland., sharon.sheehan@tcd.ie
Citation:
Eur J Obstet Gynecol Reprod Biol. 2010 Feb;148(2):121-4. Epub 2009 Nov 6.
Journal:
European journal of obstetrics, gynecology, and reproductive biology
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/208036
DOI:
10.1016/j.ejogrb.2009.10.004
PubMed ID:
19896761
Abstract:
OBJECTIVE: Caesarean section is one of the most commonly performed major operations on women worldwide. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. Various clinical guidelines address oxytocin use at the time of caesarean section. We previously reported wide variation in practice amongst clinicians in the United Kingdom in the use of oxytocin at caesarean section. The aim of this current study was to determine whether the variation in approach is universal across the individual countries of Great Britain and Ireland and whether this reflects differences in interpretation and implementation of clinical practice guidelines. STUDY DESIGN: We conducted a survey of practice in the five individual countries of Great Britain and Ireland. A postal questionnaire was sent to all lead consultant obstetricians and anaesthetists with responsibility for the labour ward. We explored the use of oxytocin bolus and infusion, the measurement of blood loss at caesarean section and the rates of major haemorrhage. Existing clinical guidelines from the National Institute for Clinical Excellence (NICE), the Royal College of Obstetricians and Gynaecologists (RCOG) and ALSO (Advanced Life Support in Obstetrics) were used to benchmark reported practice against recommended practice for the management of blood loss at caesarean section. RESULTS: The response rate was 82% (391 respondents). Use of a 5 IU oxytocin bolus was reported by 346 respondents (85-95% for individual countries). In some countries, up to 14% used a 10 IU oxytocin bolus despite recommendations against this. Routine use of an oxytocin infusion varied greatly between countries (11% lowest-55% highest). Marked variations in choice of oxytocin regimens were noted with inconsistencies in the country-specific recommendations, e.g. NICE (which covers England and Wales) recommends a 30 IU oxytocin infusion over 4h, but only 122 clinicians (40%) used this. CONCLUSIONS: Clinicians' approach to the use of oxytocin at the time of caesarean delivery varies between countries. Even in countries with on-site visits to ensure guideline implementation (e.g. Clinical Negligence Scheme for Trusts in England), deviations from guideline recommendations exist. These variations may reflect a lack of robust evidence and the need for future research in this area.
Language:
eng
MeSH:
*Cesarean Section; Female; Great Britain; Guideline Adherence; Humans; Ireland; Oxytocics/*administration & dosage; Oxytocin/*administration & dosage; Practice Guidelines as Topic; Pregnancy
ISSN:
1872-7654 (Electronic); 0301-2115 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorSheehan, Sharon Ren_GB
dc.contributor.authorWedisinghe, Lilanthaen_GB
dc.contributor.authorMacleod, Maureenen_GB
dc.contributor.authorMurphy, Deirdre Jen_GB
dc.date.accessioned2012-02-01T10:58:22Z-
dc.date.available2012-02-01T10:58:22Z-
dc.date.issued2012-02-01T10:58:22Z-
dc.identifier.citationEur J Obstet Gynecol Reprod Biol. 2010 Feb;148(2):121-4. Epub 2009 Nov 6.en_GB
dc.identifier.issn1872-7654 (Electronic)en_GB
dc.identifier.issn0301-2115 (Linking)en_GB
dc.identifier.pmid19896761en_GB
dc.identifier.doi10.1016/j.ejogrb.2009.10.004en_GB
dc.identifier.urihttp://hdl.handle.net/10147/208036-
dc.description.abstractOBJECTIVE: Caesarean section is one of the most commonly performed major operations on women worldwide. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. Various clinical guidelines address oxytocin use at the time of caesarean section. We previously reported wide variation in practice amongst clinicians in the United Kingdom in the use of oxytocin at caesarean section. The aim of this current study was to determine whether the variation in approach is universal across the individual countries of Great Britain and Ireland and whether this reflects differences in interpretation and implementation of clinical practice guidelines. STUDY DESIGN: We conducted a survey of practice in the five individual countries of Great Britain and Ireland. A postal questionnaire was sent to all lead consultant obstetricians and anaesthetists with responsibility for the labour ward. We explored the use of oxytocin bolus and infusion, the measurement of blood loss at caesarean section and the rates of major haemorrhage. Existing clinical guidelines from the National Institute for Clinical Excellence (NICE), the Royal College of Obstetricians and Gynaecologists (RCOG) and ALSO (Advanced Life Support in Obstetrics) were used to benchmark reported practice against recommended practice for the management of blood loss at caesarean section. RESULTS: The response rate was 82% (391 respondents). Use of a 5 IU oxytocin bolus was reported by 346 respondents (85-95% for individual countries). In some countries, up to 14% used a 10 IU oxytocin bolus despite recommendations against this. Routine use of an oxytocin infusion varied greatly between countries (11% lowest-55% highest). Marked variations in choice of oxytocin regimens were noted with inconsistencies in the country-specific recommendations, e.g. NICE (which covers England and Wales) recommends a 30 IU oxytocin infusion over 4h, but only 122 clinicians (40%) used this. CONCLUSIONS: Clinicians' approach to the use of oxytocin at the time of caesarean delivery varies between countries. Even in countries with on-site visits to ensure guideline implementation (e.g. Clinical Negligence Scheme for Trusts in England), deviations from guideline recommendations exist. These variations may reflect a lack of robust evidence and the need for future research in this area.en_GB
dc.language.isoengen_GB
dc.subject.mesh*Cesarean Sectionen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshGreat Britainen_GB
dc.subject.meshGuideline Adherenceen_GB
dc.subject.meshHumansen_GB
dc.subject.meshIrelanden_GB
dc.subject.meshOxytocics/*administration & dosageen_GB
dc.subject.meshOxytocin/*administration & dosageen_GB
dc.subject.meshPractice Guidelines as Topicen_GB
dc.subject.meshPregnancyen_GB
dc.titleImplementation of guidelines on oxytocin use at caesarean section: a survey of practice in Great Britain and Ireland.en_GB
dc.contributor.departmentAcademic Department of Obstetrics & Gynaecology, Coombe Women and Infants, University Hospital & Trinity College, University of Dublin, Dublin 8, Ireland., sharon.sheehan@tcd.ieen_GB
dc.identifier.journalEuropean journal of obstetrics, gynecology, and reproductive biologyen_GB
dc.description.provinceLeinster-
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