226 posters, 5 topics, 20 sessions, 598 authors, 292 institutions
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Obstetric Anaesthesia Annual Scientific Meeting 2026
14-15 May 2026 | Liverpool Convention Centre
7157338
An audit of uterotonic selection: optimising postpartum haemorrhage management in caesarean deliveries
Poster Presenter
Authors
Affiliations
Part of Topic
Quality Improvement
An Audit of Uterotonic Selection:
Optimising PPH Management in Caesarean Deliveries
Dr C Lambert, Dr S Hyder - Northampton General Hospital
Introduction
•Carbetocin, a long-acting synthetic oxytocin analogue, has been introduced into routine practice in Northampton General Hospital (NGH).
•NICE guidance (NG235) recommends carbetocin as the first-line prophylactic uterotonic for caesarean delivery and advises, where further uterotonics are required, selection should take account of agents already administered.1
•Informal observation identified continued reliance on oxytocin despite the absence of guidance supporting co-administration.
Aim
•To assess adherence to NG235 and identify opportunities to optimise pharmacological PPH management during caesarean delivery.
Methods
•Retrospective review of anaesthetic charts for all caesarean deliveries within one week (1–8 September 2025) in NGH.
•Uterotonic choice assessed against NG235 recommendations.
•A questionnaire distributed to obstetric and anaesthetic clinicians explored attitudes, knowledge, and perceived barriers to guideline implementation.
•Approved by the local audit committee.
Results
•41 caesarean deliveries identified.
•All received carbetocin, demonstrating 100% compliance for prophylaxis.
•28 required additional uterotonics, of whom 24 received carbetocin in combination with oxytocin.
•When more than one uterotonic was administered, compliance fell sharply to 4 of 28 cases (14.3%).
•In all non-compliant cases, co-administration of carbetocin and oxytocin was identified.
Questionnaire outcome
•Responses demonstrated continued reliance on oxytocin infusions and variable awareness of NICE guidance.
•34 of 37 respondents were willing to implement recommendations into practice.
•Perceived barriers included clarity of local guidance, concern regarding efficacy and side effects of alternative agents and historical reliance on oxytocin infusions.
Discussion
•Persistent reliance on oxytocin infusions appears driven by ingrained practice and uncertainty rather than opposition to guidelines.
•Targeted multidisciplinary education, local guideline revision, and decision-support tools are likely to improve compliance.
•With widespread introduction of carbetocin, these findings are relevant beyond NGH.
•Re-audit is planned to assess the impact of these quality improvement interventions on standardising PPH management.
Key message
NICE compliance for uterotonic selection in caesarean delivery fell from 100% to 14.3% when more than one agent was used; co-administration of carbetocin and oxytocin occurred in all non-compliant cases.
Reference
1. National Institute for Health and Care Excellence (NICE). NG235. Intrapartum care. Published 2023, updated 2025. www.nice.org.uk/guidance/ng235/chapter/Recommendations (Accessed 11 January 2026).