Carbetocin versus oxytocin in caesarean section with high risk of post-partum haemorrhage

Abstract

SummaryObjectives: the aims of the present study were to compare the haemodynamic effects of oxytocin and carbetocin and to assess the efficacy of these two drugs in terms of blood loss and the additional uterotonic needed in caesarean section at high risk of primary post-partum haemorrhage. Methods: women in the carbetocin group (group A) received a bolus of 100 µg IV; women in the control group (group B) received 20 IU of oxytocin in 1000 ml of 0,9% NaCl solution IV (150 mL/ hour). The main parameter evaluated was the haemodynamic effects of drugs and the need for additional uterotonic agents. In addition we compared the drop in haemoglobin level, the uterine tone, the uterine fundal state and the diuresis. Results: regarding the haemodynamic effects, both drugs have a hypotensive effect, but we found a greater reduction in blood pressure within the oxytocin group. Significantly more women needed additional uterotonic agents in the oxytocin group (23,5% vs 0%, p<0.01), though there was no significant difference in estimated blood loss and in the drop haemoglobin level (p>0.05). There was a significant difference in the diuresis, higher in carbetocin group (1300 ml ± 450 ml vs 1100 ml ± 250 ml, p=0.01). Conclusions: a single injection of carbetocin appears to be more effective than a continuous infusion of oxytocin to prevent the PPH, with a similar haemodynamic profile and minor antidiuretic effect.

Protocol for a randomized trial on nausea, vomitus and arterial hypotension comparing carbetocin and oxytocin as prevention for hemorrhage after cesarean section

“…Some studies did note a difference in the need for additional uterotonics when using carbetocin as compared to oxytocin, but these have used oxytocin in more a dilute solution or stopped the oxytocin intravenous administration very shortly after delivery. 4,5 As this is not the routine protocol in our hospital, we do not expect any difference in postpartum hemorrhage. In a later secondary analysis retrospective costs of patients can be compared between both groups in our setting…”

“…Hypotension has been reported as an important medical event in randomized trials, a hypotensive effect has been described both by oxytocin and carbetocin in randomized studies comparing carbetocin with oxytocin mainly on hemodynamic effects. 4,5 In most studies high doses of oxytocin up to 20 units have been used and resulted in significant hypotension with this high dose of oxytocin. 5 When comparing carbetocin 100 µg with oxytocin 5 IU, hemodynamic side effects have been comparable in both groups, but nausea and vomiting have not been specifically been studied.…”

“…4,5 In most studies high doses of oxytocin up to 20 units have been used and resulted in significant hypotension with this high dose of oxytocin. 5 When comparing carbetocin 100 µg with oxytocin 5 IU, hemodynamic side effects have been comparable in both groups, but nausea and vomiting have not been specifically been studied. 6 No difference in hypotension has been noted between different doses from 20 to 100 µg of carbetocin and generally hypotension is noted in 40 to 55%.…”

Double-Blind Randomized Comparison of Carbetocin Versus Oxytocin for Decrease Blood Loss from Cesarean Section in Low-Risk Uterine Atony

“…Although oxytocin is the first line uterotonic drug using for PPH prevention and treatment, carbetocin has been approved for promoting uterine contraction in order to prevent PPH in cesarean section. For the study in high risk PPH from Italy shows blood loss post cesarean section, the drop of hematocrit level and side effects in carbetocin group and oxytocin group are not different while additional uterotonic use is significantly greater in oxytocin group [6]. For the study from Canada reports that blood loss after cesarean section is significantly less in carbetocin group whereas side effects are not different [7].…”

“…Although, oxytocin is the drug of choice for PPH prevention, several trials from Italy, Canada, Philippines and United Kingdom and Cochrane Database of Systematic Reviews reported that the use of carbetocin could decrease incidences of PPH and blood transfusion, reduce the additional uterotonic drug use or uterine massage and lower side effects such as nausea and vomiting comparing to oxytocin use [6][7][8][9][10]. However, there was no significant difference in incidence of PPH reported in some researches; therefore the cost and benefit of its use should be considered [6][7][8][9][10].…”