Prophylactic use of oxytocin at caesarean section: Where are the guidelines?

摘要

Oxytocin, a polypeptide hormone produced by the posterior pituitary gland, was first synthesised by Vincent du Vigneaud, an American biochemist in the 1950s [1]. He was subsequently awarded the Nobel Prize for Chemistry for this and other work. Syntocinon?, its synthetic analogue, was introduced into medical practice in the late 1950s and its dose, administration and clinical applications have been the subject of debate ever since. The findings of a UK-wide survey into the administration of oxytocin, published in this issue of the Journal, highlights continued variation in practice throughout the UK, and the authors call for national protocols to guide dosing [2]. Post-partum haemorrhage remains a significant cause of maternal morbidity [3] and the use of oxytocin has reduced maternal morbidity worldwide [4]. However, use of oxytocin is not without its own problems as it can cause significant maternal side effects [5, 6]. Hypotension and tachycardia are common, and electrocardiographic changes suggestive of myocardial ischaemia may occur [7]. Maternal death related to oxytocin administration is documented in the Confi-dential Enquiries into Maternal Deaths, 1997-99 [8].