A randomised trial of carbetocin versus syntometrine in the management of the third stage of labour

Abstract

Objective Syntometrine is an effective uterotonic agent used in preventing primary postpartum haemorrhage but has adverse effects including nausea, vomiting, hypertension and coronary artery spasm. Carbetocin is a newly developed long-acting oxytocin analogue that might be used as an uterotonic agent. We compare the efficacy and safety of intramuscular (IM) carbetocin with IM syntometrine in preventing primary postpartum haemorrhage.Design Prospective, double-blinded, randomised controlled trial.Setting Delivery suite of a university-based obstetrics unit.Population Women with singleton pregnancy achieving vaginal delivery after and throughout 34 weeks.Methods Three hundred and twenty-nine eligible women were randomised to receive either a single dose of 100 microgram IM carbetocin or 1 ml IM syntometrine (a mixture of 5 iu oxytocin and 0.5 mg ergometrine) at the end of second stage of labour.Main outcome measures Difference in haemoglobin drop measured 2 days after delivery between the two groups.Results There was no difference in the drop of haemoglobin concentration within the first 48 hours between the two groups. The incidence of additional oxytocic injections, postpartum haemorrhage (blood loss ‡ 500 ml) and retained placenta were also similar. The use of carbetocin was associated with significant lower incidence of nausea (relative risk [RR] 0.18, 95% confidence interval [CI] 0.04-0.78), vomiting (RR 0.1, 95% CI 0.01-0.74), hypertension 30 minutes (0 versus 8 cases, P < 0.01) and 60 minutes (0 versus 6 cases, P < 0.05) after delivery but a higher incidence of maternal tachycardia (RR 1.68, 95% CI 1.03-3.57).Conclusions IM carbetocin is as effective as IM syntometrine in preventing primary postpartum haemorrhage after vaginal delivery. It is less likely to induce hypertension and has a low incidence of adverse effect. It should be considered as a good alternative to conventional uterotonic agents used in managing the third stage of labour.Keywords Carbetocin, primary postpartum haemorrhage, syntometrine, third stage of labour, uterotonic agents.Please cite this paper as: Leung S, Ng P, Wong W, Cheung T. A randomised trial of carbetocin versus syntometrine in the management of the third stage of labour.

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

“…Preeclampsia is associated with thrombocytopoenia and coagulopathy, and active management of the third stage [398], avoiding ergometrine (ergonovine maleate), should be performed to avoid postpartum haemorrhage [399][400][401][402][403][404].…”

Uterine Atony: Management Strategies

“…The number of women requiring uterotonic intervention (either additional uterotonic agents or uterine massage) was significantly lower in the Carbetocin group (Boucher et al, 2004). Leung et al randomised 329 women to intramuscular Carbetocin and intramuscular syntometrine and found no difference in the decline of haemoglobin two days after delivery (Leung et al, 2006). Although the rate of PPH was lower in the Carbetocin group, it was not statistically significant (Leung et al, 2006).…”

“…Leung et al randomised 329 women to intramuscular Carbetocin and intramuscular syntometrine and found no difference in the decline of haemoglobin two days after delivery (Leung et al, 2006). Although the rate of PPH was lower in the Carbetocin group, it was not statistically significant (Leung et al, 2006). About 120 women were randomised to Carbetocin and Syntometrine groups had showed lower haemoglobin drop in the Carbetocin group (Nirmala et al, 2009).…”

Carbetocin versus Oxytocin for the Prevention of Postpartum Haemorrhage

“…The authors concluded that carbetocin should be considered a good alternative to conventional uterotonics in preventing postpartum haemorrhage after vaginal delivery. In this retrospective study, carbetocin displayed significantly better uterotonic activity than an oxytocin/ ergometrine combination containing less than half the ergometrine dose contained in syntometrine 27 . However, these findings are still of interest as these retrospective data more closely reflect everyday clinical practice.…”

“…However, they remain useful therapeutic options for postpartum haemorrhage treatment when other interventions prove ineffective 21 . Recent interest has focused on the prophylactic use of the oxytocin receptor agonist carbetocin [22][23][24][25][26][27][28][29] . Here we review the most recent clinical data regarding the efficacy of carbetocin in the prevention of postpartum haemorrhage following caesarean section and vaginal delivery, and provide an update on the safety and tolerability in comparison to conventional uterotonic agents.…”