A national survey of oxytocin use during caesarean section in Zimbabwe

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.