Carbetocin versus Oxytocin: A Comparative Study to Prevent Postpartum Hemorrhage in Pre-eclamptic Women Delivered by Caesarean Section

Abstract

Background: Postpartum hemorrhage and hypertensive disorders are the greatest contributors to maternal death in developing countries accounting for more than 50% of direct causes.Objective: This study aimed to improve the clinical outcomes of carbetocin versus oxytocin in preventing postpartum hemorrhage in women with pre-eclampsia during C aesarean Section (CS). Patients and methods: This study included 120 pre-eclamptic pregnant women and were randomized (by alternation) into two groups of 60 patients: Group A received a single dose of carbetocin (100μg) diluted in 100ml 0.9% Nacl administered slowly over (30-60 seconds) intravenously after the delivery of the baby, while Group B received oxytocin (40 IU diluted in 100ml of 0.9% Nacl run at 25 ml per hour over 4 hours) intravenously after the delivery of baby. Results: Regarding preoperative hemoglobin and HCT, there was no statistically significant difference between the 2 studied groups. There were statistical significant differences between the 2 groups in postoperative hemoglobin and HCT with higher levels among Group A compared with Group B. There was significant increase in frequency of blood transfusion and need of other uterotonic drugs in oxytocin group compared with carbetocin group. No significant difference was observed between the 2 studied groups in frequency of headache, but there were statistically significant increase in frequency of nausea, vomiting, abdominal pain and oligourea in oxytocin group compared to carbetocin group. There was significant increase in frequency of elevated temperature in carbetocine group compared to oxytocin group. Conclusion: Carbetocin has a superior effect on oxytocin for prevention of postpartum hemorrhage in women with pre-eclampsia.

Effects of Carbetocin and Oxytocin on Haemodynamic among Women with Post-Partum Hemorrhage after Caesarean Section: A Single Blind Parallel Arm Randomized Controlled Trial

“…Butwick et al 13 obtained that systolic blood pressure was lower in the oxytocin group at the 5 th minute after administration, at uterine closure time, at 12 hours postoperatively. Al Anwar et al 11 showed there were significant changes with time for each of systolic blood pressure and diastolic blood pressure respectively but no significant main effect of group, which are similar with the current study. In this current study it was observed that before administration of drug; mean maternal blood loss was found 376.4±110.4 mL in group I and 439.4±199.9 mL in group II.…”

“…The difference was not statistically significant (p>0.05) between two groups, which is closely resembled with the present study. On the other hand, Al Anwar et al 11 had observed the mean age was 33.0±4.6 years in carbetocin group and 33.3±4.6 years in oxytocin group. Similarly, Magann et al 12 observed at baseline, there was no significant difference between carbetocin and oxytocin in terms of mean age, where mean was 30 years and 31 years respectively.…”

“…Carbetocin is a synthetic analogue of oxytocin with a long half-life approximately 4 to 10 times longer than oxytocin. Moreover, carbetocin significantly reduces the need for additional uterotonic agents or uterine message to prevent excessive bleeding compared to oxytocin 11 . By using this promising uterotonic, it can be prevented severe blood loss and it will help to reduce maternal morbidity and mortality 12 .…”

Comparison between intravenous carbetocen and rectal misopristole as prophylaxis for postpartum hemorrhage in lower segment caesarean section among low-risk patients.

“…In this research, we show no statistically significant difference in preoperative blood pressure across patients taking IV carbetocin and patients taking rectal misoprostol. (14) , who hoped to enhance the clinical outcomes of carbetocin contrary to oxytocin to minimize postpartum hemorrhage in patients with pre-eclampsia undergoing Caesarean Section (CS), agreed with the outcomes of the study, no statistically significant difference on presystolic and diastolic blood pressure through the tested groups (P>0.05).…”

Comparison of Complication and Post-Operative Infection Rate Between Application of Carbetocin and Oxytocin during Management of Post-Partum Hemorrhage after Caesarean Section

“…Oxytocin is relatively safe when used at recommended doses, and side effects are uncommon 1 . The hemodynamic effects of an oxytocin bolus consist of systemic vasodilatation, with hypotension, tachycardia, and an increase in cardiac output and pulmonary artery pressure, resulting in brief hypotension and tachycardia in a dose dependent manner [2][3][4] . It is an effective drug for the control of post-partum hemorrhage, but the disadvantage is its short half-life of 4 to 10 minutes, regularly requiring a continuous intravenous infusion or repeated intramuscular injections 5 .…”