Carbetocin vs oxytocin for prevention of postpartum hemorrhage after vaginal delivery

Abstract

Objective: To evaluate the efficacy and safety of carbetocin for prevention of postpartum hemorrhage in women undergoing vaginal delivery compared with oxytocin. Methods: We conducted a systemic literature search in PubMed, the Cochrane Library, and Embase without language restrictions from inception of each of database to November 18th, 2018. Randomized controlled trials with outcome measure of blood loss ≥500 ml were eligible if they compared carbetocin with oxytocin to prevent postpartum hemorrhage during the third stage of labor in women undergoing vaginal delivery. Results: This meta-analysis of 5 randomized controlled trials (30,314 women) indicated that there was no significant difference between carbetocin and oxytocin in blood loss ≥500 ml in women undergoing vaginal delivery (relative risks (RRs), 0.52; 95% confidence intervals (CIs), 0.24 to 1.15; P = .11; I 2 = 69%). Sensitivity analyses showed the same results. No significant differences were found in blood loss ≥1000 ml, use of additional uterotonic agents, blood transfusion, uterine massage, flushing, vomiting, abdominal pain, nausea, dizziness, headache, palpitation, itching, and shivering. Conclusions: This meta-analysis showed that carbetocin was as effective and safe as oxytocin for prevention of postpartum hemorrhage in women undergoing vaginal delivery, and the choice of carbetocin for routine prophylaxis will depend on cost-effectiveness.

Storage conditions of oxytocin in a tropical climate in a low‐income country

“…More research is needed to compare the efficacy of carbetocin with other uterotonic drugs during exposure to uncontrolled storage conditions in low‐income countries, similar to those encountered in the present study. Additionally, the cost‐effectiveness in these settings should be analyzed, as carbetocin is currently up to 100 times more expensive than oxytocin 18 …”

“…Additionally, the cost-effectiveness in these settings should be analyzed, as carbetocin is currently up to 100 times more expensive than oxytocin. 18 The difference between the measured minimum temperatures in the medicine boxes compared with the storage locations, might be due to variances of the location of the boxes and the Safe-Rx cards within the refrigerators. There can be a difference of up to 8°C between the temperatures measured on the shelves of the refrigerator door and against the back inside the same refrigerator.…”

A study protocol for the cardiac effects of a single dose of either oxytocin 2.5 IU or carbetocin 100 µg after caesarean delivery: a prospective randomized controlled multi-centre trial in Norway

“…2 Carbetocin, a synthetic oxytocin receptor agonist with a significantly longer half-life than oxytocin, reduces postpartum blood loss by stimulating uterus contraction. [4][5][6] Carbetocin has been in clinical use for the prevention of postpartum haemorrhage in Europe since 1999, and a room-temperature stable formulation has been available since 2015. 7 The efficacy is documented in several randomized controlled trials and meta-analyses.…”

Efficacy of carboprost tromethamine combined with leonurus japonicus for prevention of postpartum hemorrhage in high-risk pregnant women

“…Despite great efforts to reduce maternal mortality, postpartum hemorrhage remains the largest direct cause of maternal mortality, accounting for nearly a quarter of all deaths worldwide, and contributes to long-term disability and severe maternal morbidity, such as blood transfusions, emergency surgery, and admission to the intensive care unit. [ 1 ] The American College of Obstetricians and Gynecologists defines early postpartum hemorrhage as total blood loss associated with signs and symptoms of hypovolemia of at least 1000 mL within 24 hours after delivery. [ 2 ] Although maternal mortality has become a rare event in developed countries, it remains an important indicator of the quality of obstetric care and the health status of mothers.…”