Maternal outcomes before and after new oxytocin protocol at Chris Hani Baragwanath Academic Hospital

Kotze, Adri
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Background: Obstetric haemorrhage remains the third most common cause of death in South Africa, where 35% are due to postpartum haemorrhage at caesarean section. Uterotonic agents are used to prevent bleeding associated with uterine atony. Higher doses of oxytocin have previously been reported to reduce the incidence of uterine atony with varying protocols for administration. Objectives The primary objective w as t o describe the incidence of post-partum haemorrhage three months before and three months after implementation of the new high dose oxytocin protocol at Chris Hani Baragwanath Academic Hospital. Secondary objectives were to describe the socio-demographic, clinical characteristics, blood loss and associated morbidity. Methods: This was a c ross sectional retrospective record review three months before and three months after the implementation of a high dose oxytocin protocol. The study included all women that underwent caesarean section between 1 November 2016 and 30 April 2017 with a gestation of > 24 weeks and who had a blood loss of > 1 000 mL. Results: A total of 4 604 Caesarean sections were performed during the study period. Of these, 2 162 were performed before the implementation of the new oxytocin protocol and 2 442 after. The incidence of post-partum haemorrhage was 4.8% (n=91) in the Before group and 3.9% (n=89) in the After group (p=0.17). There was a 17.9% change in incidence of postpartum haemorrhage between the groups after the protocol was implemented (p=0.17). There was no difference in the socio-demographic and clinical characteristics between the two groups. Pre-operative risk factors for postpartum haemorrhage between the two groups were similar, except for a higher trend of twin deliveries in the before group (15.5% versus 4.8%; p=0.07). There was no significant difference in uterine atony between the Before and After groups (21.8% and 30.1%, p=0.30). The most common intra operative finding in the Before and After groups was uterine tears (37.5% versus 27.4%, p=0.24). More women in the After group had anaemia at booking (25.9% and 41.9%; p=0.06). The median blood loss in both groups was 1 200 mL. There was no statistical difference in number of high care admissions, relook laparotomies, and hysterectomies between the groups. Conclusion: There was no difference in the incidence of postpartum haemorrhage at caesarean section after the implementation of a high dose oxytocin protocol for prevention of postpartum haemorrhage. There was no difference in associated morbidity before and after implementing the new protocol
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine (in Obstetrics and Gynaecology), 2021