Use of oxytocin during Caesarean section at Princess Marina Hospital, Botswana: An audit of clinical practice

Abstract

BackgroundOxytocin is widely used for the prevention of postpartum haemorrhage. In the setting of Caesarean section (CS), the dosage and mode of administrating oxytocin differs according to different guidelines. Inappropriate oxytocin doses have been identified as contributory to some cases of maternal deaths. The main aim of this study was to audit the current standard of clinical practice with regard to the use of oxytocin during CS at a referral hospital in Botswana.MethodsA clinical audit of pregnant women having CS and given oxytocin at the time of the operation was conducted over a period of three months. Data included indications for CS, oxytocin dose regimen, prescribing clinician's designation, type of anaesthesia for the CS and estimated blood loss.ResultsA total of 139 case records were included. The commonest dose was 20 IU infusion (31.7%). The potentially dangerous regimen of 10 IU intravenous bolus of oxytocin was used in 12.9% of CS. Further doses were utilized in 57 patients (41%). The top three indications for CS were fetal distress (36 patients, 24.5%), dystocia (32 patients, 21.8%) and a previous CS (25 patients, 17.0%). Estimated blood loss ranged from 50 mL – 2000 mL.ConclusionThe use of oxytocin during CS in the local setting does not follow recommended practice. This has potentially harmful consequences. Education and guidance through evidence based national guidelines could help alleviate the problem.

Type of anaesthesia for caesarean section and failure rate in Princess Marina Hospital, Botswana’s largest referral hospital

“…All our patients received an initial bolus dose of 10 IU regardless of the comorbid condition and indication for CS while the 2010 British Journal of Anaesthesia has concluded the routine use of 5 units oxytocin bolus during elective C-section can no longer be recommended as adequate uterine tone can be obtained with lower doses of oxytocin (0.5 – 3) 32 . The study by Tsima et al in 2013 at PMH on the use of oxytocin during CS revealed that the local setting does not follow international practice and recommended the need for national guidelines 33 . According to the 2017 Up-to-date, oxytocin bolus should be given slowly in a dose of less than 3IU 18 .…”

A root-cause analysis of maternal deaths in Botswana: towards developing a culture of patient safety and quality improvement

“…In Botswana, an audit of management of acute respiratory infections and diarrhoea in children revealed suboptimal adherence to guidelines on history-taking and poor clinical examination of cases [ 20 ]. Other studies in Botswana showed that only 30% of health professionals used the recommended dose of oxytocin at caesarean section [ 21 ] while National Guidelines on initiation of treatment for tuberculosis were not followed in 47% of cases [ 22 ].…”

“…Further research is necessary on staff attitudes towards their patients, why they did not communicate well with each other or with patients and their families, and why staff neglected to use protocols or guidelines. These audits provide the backbone for postgraduate dissertations, offering opportunities for publication in regional journals [ 21 , 26 , 27 ]. Detailing the difficulties in conducting audits is also necessary for removing obstacles [ 26 ].…”