Carbetocin versus Oxytocin and Misoprostol in prevention of atonic post-partum hemorrhage in high risk patients planed for cesarean delivery

Abstract

Background: Post-partum hemorrhage prevention (PPH) is considered a major issue due to its effect on maternal morbidity and mortality. The objective of this study was to compare efficacy of Carbetocin in prevention of atonic post-partum hemorrhage in high risk patients undergoing elective caesarean section in comparison to Oxytocin and Misoprostol.Methods: 150 pregnant women prepared for elective caesarean section were classified into 3 groups; Group I (50 patients received Carbetocin 100 mg I.V infusion), Group II (50 patients received 20 IU of Oxytocin infusion on 1000 ml of normal saline solution) and Group III (50 cases received Misoprostol 400 µg per rectum immediately before induction of anaesthesia). Assessment of PPH and its degree was determined according to amount of blood loss during and for first 24 hours of caesarean delivery, also further need for haemostatic measures were also assessed.Results: There was a statistically significant difference in PPH among the three groups 6, 14 and 12% for group I, II and III respectively (P <0.001), major PPH was 0, 4 and 6% for the same groups respectively (P <0.001). The need for additional uterotonic agents was significantly lesser in Group I compared to Group II and III (2% versus 8 and 12% respectively P = 0.02) also the need for additional surgical measures was significantly lesser among the three groups (P= 0.00). The drop in Hb level and haematocrit value was significantly lesser in group I compared to group II& III (P <0.05). The need for blood transfusion was significantly lesser in Group I compared to group II and III (0% versus 12% p <0.0001)Conclusions: Carbetocin was superior to Oxytocin and Misoprostol in prevention of atonic PPH in high risk patients underwent elective caesarean delivery. Carbetocin should be administered for all cases undergoing elective CS and carry a risk factor for postpartum hemorrhage.

Carbetocin versus Misoprostol in Reducing Blood Loss during Cesarean Section in low risk patients. A Randomized Controlled Trial

“…This can be explained by the less number of patients with uterine atony in carbetocin group. This was in agreement with Ali AE-NAE-G et al (2017 ) who found that carbetocin decreases the need for blood transfusion after cesarean [18] . Also, uterine atony which was more significant in the misoprostol group necessitate use of more oxytocin, this agrees with (Sull, Chong YS, Samuel M 200) who concluded that carbetocin significantly decreases the need for other uterotonic drugs [19] .…”

“…Uterine atony which was more significant in the misoprostol group necessitate additional surgical procedure to control bleeding such as uterine artery ligation in 3 (2%) patients and uterine compression sutures in 8 (11%) patients. This is in agreement with Ali AE-NAE-G et al (2017) who found that carbetocin decreases the need for surgical measures to decrease blood loss during operation [18] .…”

The Effect of Carbetocin versus Misoprostol versus Ergometrine for Controlling Bleeding after Cesarean Section in Primigravidae

“…In the present study, the need for blood transfusion was significantly lower in the carbetocin group. This was in agreement with Ali et al [25] and Moustafa et al [17] who found that carbetocin decreases the need for blood transfusion after cesarean.…”

Prevention of postpartum haemorrhage in patients with severe preeclampsia using Carbetocin versus Misoprostol

“…In the current research there is no statistically substantial variance (p-value > 0.05) among studied groups with respect to post-partum HCT. In a study done by Ali et al 1 , that was performed to evaluate the efficacy of Carbetocin relative to Oxytocinin in the avoidance of atonic post-partum hemorrhage in high-danger sufferers experiencing optional caesarean section and misoprodtol, hematocrit value assessment preoperative and 48 hours postoperatively after elective cesarean delivery had a mildly substantial disparity among the three groups studied (p <0.05)…”