Double-blind comparison of carbetocin versus oxytocin in prevention of uterine atony after cesarean section

Dansereau, Jerome; Joshi, Anil; Helewa, Michael; Doran, T.A.; Lange, Ian; Luther, Edwin R.; Farine, Dan; Schulz, M.; Horbay, G.L.A.; Griffin, Patricia; Wassenaar, Willem

doi:10.1016/s0002-9378(99)70271-1

Cited by 164 publications

(121 citation statements)

References 7 publications

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“…1,4 The search for the minimum effective dose of carbetocin is well justified, similar to what has occurred for oxytocin, as carbetocin is thought to have a side effect profile similar to that of oxytocin. [6][7][8]16 The reported side effects of carbetocin during CD include hypotension, headache, nausea, vomiting, tremor, shortness of breath, abdominal pain, back pain, and flushing. 6,7,17 Overall, the incidence of these side effects in our study was comparable with previous data.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8]16 The reported side effects of carbetocin during CD include hypotension, headache, nausea, vomiting, tremor, shortness of breath, abdominal pain, back pain, and flushing. 6,7,17 Overall, the incidence of these side effects in our study was comparable with previous data. 8 In our study, however, there was a high incidence of hypotension.…”

Section: Discussionmentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

“…6,7 Previous studies showed that women treated with carbetocin 100 lg iv were twice less likely to need additional uterotonic agents when compared with traditional oxytocin regimens. 7,8 The incidence and types of side effects between carbetocin and oxytocin have been shown to be similar. 8 In 2009, the Society of Obstetricians and Gynaecologists of Canada (SOGC) suggested carbetocin as the first choice of uterotonic agent to prevent postpartum hemorrhage (PPH) after elective CD.…”

Section: Résumémentioning

confidence: 99%

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Carbetocin at elective Cesarean delivery: a randomized controlled trial to determine the effective dose

Cordovani

Balki

Farine

et al. 2012

Can J Anesth/J Can Anesth

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Purpose The primary objective of our study was to determine the minimum intravenous dose of carbetocin required to produce adequate uterine contraction in 95% of women (effective dose [ED] 95 ) undergoing elective Cesarean delivery (CD). Methods Eighty term pregnant women with low risk for postpartum hemorrhage (PPH) undergoing elective CD under spinal anesthesia were randomly allocated to receive carbetocin intravenously in doses of 80 lg, 90 lg, 100 lg, 110 lg, or 120 lg upon delivery. The consultant obstetrician evaluated the efficacy of the patient's uterine tone as satisfactory or unsatisfactory. In case of unsatisfactory uterine tone, additional uterotonics were administered as per routine institutional practice. Side effects were monitored during the study period. The main outcome measure was satisfactory uterine tone at two minutes after carbetocin administration. Results Satisfactory uterine tone was obtained in 70 subjects (87%) within the dose range of 80-120 lg of carbetocin. It was not possible to calculate the ED 95 of carbetocin due to the even distribution of women with satisfactory uterine tone across all dose groups (P = 0.99). Similarly, the side effects were similar across all dose groups. There was a high overall incidence of hypotension (55%) following the administration of carbetocin.Conclusions In women at low risk for PPH undergoing elective CD, carbetocin doses of 80-120 lg are similarly effective. There is a high incidence of hypotension associated with carbetocin in these doses, and further studies with doses lower than 80 lg are warranted to assess the balance of efficacy and side effects. This trial was registered at www.clinicaltrials.gov (NCT01262742). RésuméObjectif L'objectif principal de notre e´tude e´tait de de´terminer la dose intraveineuse minimum de carbe´tocine ne´cessaire pour obtenir une contraction ute´rine approprie´e chez 95 % des femmes (dose efficace [DE] 95 ) subissant une ce´sarienne programme´e. Méthodes Quatre-vingts femmes enceintes a`terme ayant un faible risque d'he´morragie du postpartum subissant une ce´sarienne programme´e sous rachianesthe´sie ont e´teŕ andomise´es pour recevoir des doses intraveineuses de 80 lg, 90 lg, 100 lg, 110 lg ou 120 lg de carbe´tocine au moment de l'accouchement. L'obste´tricien a e´valueĺ 'efficacite´du tonus ute´rin de la patiente comme satisfaisant ou non satisfaisant. En cas de tonus ute´rin non satisfaisant, des me´dicaments ute´rotoniques supple´mentaires ont e´teá dministre´s conforme´ment aux pratiques habituelles de l'e´tablissement. Les effets inde´sirables ont e´te´surveille´s pendant la dure´e de l'e´tude. Le crite`re de jugement principal a éte´un tonus ute´rin satisfaisant deux minutes apre`s l'administration de carbe´tocine.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

See 2 more Smart Citations

Carbetocin at elective Cesarean delivery: a randomized controlled trial to determine the effective dose

Cordovani

Balki

Farine

et al. 2012

Can J Anesth/J Can Anesth

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“…This therapeutic indication is supported by the results of two published controlled clinical trials 35,36 . The first study from Montreal (Canada) was a parallelgroup, randomised, double-blind, double-dummy trial, comparing uterotonic efficacy and safety of carbetocin and oxytocin in 57 women undergoing elective caesarean section 35 . A single 100 µg intravenous injection of carbetocin following placental delivery was at least as effective as a 16-h intravenous infusion of 32.5 IU oxytocin in controlling intraoperative blood loss.…”

Section: Carbetocin At Caesarean Deliverymentioning

confidence: 71%

Carbetocin versus Oxytocin for the Prevention of Postpartum Haemorrhage

Begum

Shaha²,

Mahbuba³

et al. 2016

Faridpur Med Coll J

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Abstract:Postpartum haemorrhage is the leading cause of maternal mortality worldwide. Total 67-80% of cases are caused by uterine atony. Preventive measures include prophylactic drug use to aid uterine contraction after delivery, thus avoiding severe blood loss and reducing maternal morbidity and mortality. Carbetocin is a synthetic analogue of oxytocin with a long half-life which ensure more effective contraction and less adverse effects. It can be administered as a single dose injection either intravenously or intramuscularly rather than as an infusion over several hours as is the case with oxytocin. Carbetocin is currently indicated for prevention of uterine atony after delivery by caesarean section in spinal or epidural anaesthesia. A reduced need for additional uterotonics was observed with carbetocin vs. oxytocin in high-risk women and carbetocin was at least as effective as syntometrine in low-risk women. Carbetocin is effective treatment for the prevention of postpartum haemorrhage not only following caesarean delivery but also after vaginal delivery in high-risk women and those who suffer from hypertensive disorders in pregnancy. Further research is required to assess whether prophylactic carbetocin is superior to conventional uterotonic agents following vaginal delivery in low-risk women.

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Oxytocin agonists for preventing postpartum haemorrhage

Chong

Melamed

2007

Cochrane Database of Systematic Reviews

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Double-blind comparison of carbetocin versus oxytocin in prevention of uterine atony after cesarean section

Cited by 164 publications

References 7 publications

Carbetocin at elective Cesarean delivery: a randomized controlled trial to determine the effective dose

Carbetocin at elective Cesarean delivery: a randomized controlled trial to determine the effective dose

Carbetocin versus Oxytocin for the Prevention of Postpartum Haemorrhage

Oxytocin agonists for preventing postpartum haemorrhage

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