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15-Year Analysis of Second-Line Uterotonic Use at A Large Teaching Hospital in The United States
Abstract Number: F-15
Abstract Type: Original Research
Background: Uterine atony has been recognized as the main cause of postpartum hemorrhage (PPH). For PPH due to uterine atony, second-line uterotonic agents, such as methylergonovine, carboprost, and misoprostol, have been highly recommended by the American College of Obstetricians and Gynecologists (ACOG) since 2006. Bateman et al demonstrated that an increased use of second-line uterotonic agents in the recent years. In this study, we investigated the use of second-line uterotonic agents at a large teaching hospital.
Methods: We conducted electronic database search at the Brigham and Woman’s hospital (BWH). Patients who underwent cesarean delivery or cesarean hysterectomy were retrieved from 1999 to 2014. The medication usage data of methylergonovine, carboprost, misoprostol were analyzed.
Results: The overall usage of all second-line uterotonic agents increased in the past 15 years. (Figure 1a, 2a, 3a) After adjusting with patient volume, our data indicated the usage of methylergonovine and misoprostol decreased significantly in the recent years. (Figure 1b, 3b) On the other hand, there was a steady increase of carboprost use. (Figure 2b) Obstetric providers’ usage pattern change between 2004 and 2014 was shown in Figure 4 and 5. While the usage of carboprost increased across all providers, we are continuing data process for a much thorough analysis at the SOAP meeting.
Discussion: We observed an increased use of second-line uterotonic agents of methylergonovine and carboprost with an obvious favor towards carboprost at our institution over the past 15 years. We are exploring the potential underlining causes and speculated that providers’ personal preferences could be one of the leading reasons. Recent review data suggested methylergonovine could be more effective which might also reduce PPH morbidity. Nevertheless, most of the providers may not aware of the cost associated with each of these different therapies. A more evidence based practice is likely the best approach.
1. Potts M, et al. Lancet 2010;375:1762.
2. ACOG. ACOG Practice bulletin no. 76. Obstet Gynecol 2006;108:1039.
3. Bateman BT, et al. Anesth Analg 2014;119:1344.
4. Butwick AJ, et al. Am J Obstet Gynecol 2015;212(5):642.e1.