Comparison of carbetocin and oxytocin effectiveness for prevention of postpartum hemorrhage after caesarean delivery

Brzozowska, Maria; Lisiecki, Dawid; Kowalska-Koprek, Urszula; Karowicz-Bilińska, Agata

doi:10.17772/gp/1996

Cited by 3 publications

(2 citation statements)

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“…However, the PPH rates given in these studies were not stratified according to the indications for cesarean section. In addition, the prepartal oxytocin status was not considered as confounding factor by conducting subgroup analyses [ 34 – 63 ].…”

Section: Resultsmentioning

confidence: 99%

Lack of controlled studies investigating the risk of postpartum haemorrhage in cesarean delivery after prior use of oxytocin: a scoping review

Bischoff

Nothacker

Lehane

et al. 2017

BMC Pregnancy Childbirth

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BackgroundPostpartum haemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Experimental and clinical studies indicate that prolonged oxytocin exposure in the first or second stage of labour may be associated with impaired uterine contractility and an increased risk of atonic PPH. Therefore, particularly labouring women requiring cesarean delivery constitute a subset of patients that may exhibit an unpredictable response to oxytocin. We mapped the evidence for comparative studies investigating the hypothesis whether the risk for PPH is increased in women requiring cesarean section after induction or augmentation of labour.MethodsWe performed a systematic literature search for clinical trials in Medline, Embase, Web of Science, and the Cochrane Library (May 2016). Additionally we searched for ongoing or unpublished trials in clinicaltrials.gov and the WHO registry platform. We identified a total of 36 controlled trials investigating the exogenous use of oxytocin in cesarean section. Data were extracted for study key characteristics and the current literature literature was described narratively.ResultsOur evidence map shows that the majority of studies investigating the outcome PPH focused on prophylactic oxytocin use compared to other uterotonic agents in the third stage of labour. Only 2 dose-response studies investigated the required oxytocin dose to prevent uterine atony after cesarean delivery for labour arrest. These studies support the hypotheses that labouring women exposed to exogenous oxytocin require a higher oxytocin dose after delivery than non-labouring women to prevent uterine atony after cesarean section. However, the study findings are flawed by limitations of the study design as well as the outcome selection. No clinical trial was identified that directly compared exogenous oxytocin versus no oxytocin application before intrapartum cesarean delivery.ConclusionDespite some evidence from dose-response studies that the use of oxytocin may increase the risk for PPH in intrapartum cesarean delivery, current research has not investigated the prepartal application of oxytocin in well controlled clinical trials. It was striking that most studies on exogenous oxytocin are focused on PPH prophylaxis in the third stage of labour without differing between the indications of cesarean section and hence the prepartal oxytocin status.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1584-1) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Lack of controlled studies investigating the risk of postpartum haemorrhage in cesarean delivery after prior use of oxytocin: a scoping review

Bischoff

Nothacker

Lehane

et al. 2017

BMC Pregnancy Childbirth

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“…Many studies worldwide compared misoprostol to oxytocin [14,15] and carbetocin to oxytocin [11,16] in reducing blood loss during cesarean section. However, few studies compared carbetocin to misoprostol in reducing blood loss during cesarean section [17].…”

Section: Discussionmentioning

confidence: 99%

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

Abdeldayem

Elnamoury²,

Othman³

et al. 2022

JAMMR

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Background: Women undergoing cesarean section have a high risk of blood loss and so are more likely to need a blood transfusion. The aim of this work was to compare the effectiveness of using carbetocin versus misoprostol versus ergometrine for controlling bleeding after cesarean section in primigravidae. Methods: This prospective randomized clinical trial was conducted on 150 patients aged from18-35 years old, primigravidae with singleton pregnancy undergoing elective cesarean section. Participants were divided into three equal groups: carbetocin group (group C) received a single 1-ml ampoule of carbetocin (100 μg/mL) added to 10 cm saline intravenously following the delivery of the neonate, misoprostol group (group M) received misoprostol 400ug per rectum immediately after induction of anesthesia in operating theater and ergometrine group (group E) received 0.2 mg of ergometrine intramuscularly in the first minute after delivery of the baby. Results: The amount of blood in suction jar, amount of blood loss, Hb change and HTC change were significantly higher in the misoprostol group and ergometrine group than in the carbetocin group (p <0.05) and in the ergometrine group than the misoprostol group (p <0.001). Post-operative Hb in the ergometrine group was significantly lower in the carbetocin group (p =0.001). Conclusions: Carbetocin can be considered a superior choice to misoprostol and ergometrine in reducing blood loss during CS in primigravidae.

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Evidence for carbetocin in obstetric hemorrhage

Lluglla¹,

Analuisa²,

Guamán³

et al. 2023

Salud, Ciencia y Tecnología

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Introducción: un procedimiento habitual es administrar agentes de uterotónicos de forma regular para la profilaxis de hemorragia postparto y poscesárea. El fármaco uterotónico típico aconsejado para este uso es la oxitocina, sin embargo, existe literatura que indica mejores efectos beneficios con la carbetocina debido a que presenta una actividad uterotónica sostenida y prolongada, además es segura y bien tolerada. Objetivo: esbozar los datos de carbetocina que se han encontrado hasta ahora en relación con la hemorragia obstétrica. Métodos: Para esta revisión bibliográfica se localizaron palabras clave relacionadas con el tema de la carbetocina en la hemorragia obstétrica mediante descriptores en ciencias de la salud, y posteriormente se buscaron en bases de datos y buscadores como Google Scholar, Pubmed, Lilacs, SciELO, Cochrane y Pubmed. De un total de 100 bibliografías fueron considerados 32 artículos. Resultados: la carbetocina es un fármaco termoestable con una semivida aproximadamente 4-10 veces superior a la oxitocina, con la actividad uterotónica sostenida solo con la administración de una dosis única (100 μg) por vía intravenosa o intramuscular. Conclusiones: la carbetocina es un fármaco seguro para la prescripción en pacientes que presenten patologías específicas, ya que mantiene un efecto uterotónico prologando, útil en las hemorragias poscerárea. Su uso aún no está totalmente promulgado debido al alto costo que representa en la actualidad.

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Comparison of carbetocin and oxytocin effectiveness for prevention of postpartum hemorrhage after caesarean delivery

Cited by 3 publications

References 0 publications

Lack of controlled studies investigating the risk of postpartum haemorrhage in cesarean delivery after prior use of oxytocin: a scoping review

Lack of controlled studies investigating the risk of postpartum haemorrhage in cesarean delivery after prior use of oxytocin: a scoping review

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

Evidence for carbetocin in obstetric hemorrhage

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