EXPRESSION OF CONCERN: Carbetocin versus rectal misoprostol for management of third stage of labor among women with low risk of postpartum hemorrhage

Abstract

ObjectiveTo compare effectiveness and safety of carbetocin and misoprostol for prevention of postpartum hemorrhage (PPH) among low‐risk women.MethodsRandomized controlled trial among 150 pregnant women with low risk of PPH admitted for vaginal delivery at Kasr Al Ainy Hospital, Cairo, Egypt, between July 2018 and May 2019. Participants were assigned to two groups by a web‐based randomization system ensuring allocation concealment. After neonatal delivery, the carbetocin group received one ampoule of carbetocin (100 μg/mL) intravenously and the misoprostol group received two rectal tablets of misoprostol (800 μg) for active management of the third stage. Blood pressure, blood loss, and hemoglobin levels were monitored. The primary outcome measure was need for additional uterotonic drugs.ResultsThe carbetocin group had significantly less blood loss (P<0.001), shorter third stage (P<0.001), and less need for additional uterotonics (P=0.013) or uterine massage (P=0.007). The two drugs were hemodynamically safe. Hemoglobin levels after delivery were comparable in the two groups (P=0.475). Adverse effects were more common in the misoprostol group (P<0.001).ConclusionAmong low‐risk women, carbetocin seems to be a better alternative to misoprostol for active management of the third stage of labor; it reduced blood loss and use of additional uterotonic drugs.ClinicalTrials.gov: NCT03556852

Análise das intervenções utilizadas na prevenção e controle da hemorragia pós-parto: revisão integrativa da literatura

“…Os quatorze estudos fizeram caracterização clínica das intervenções, conforme mostra o quadro 4. Todos os estudos descreveram o tipo de parto onde ocorreu a intervenção no manejo da hemorragia pós-parto, sendo prevalente o parto vaginal (Rangel et al, 2019;Begley et al, 2019;Salati et al, 2019;Asmat et al, 2017;Quibel et al, 2016;Suarez et al, 2020;Escobar et al, 2020;Şentürk et al, 2016;Sanad et al, 2018;Gallos et al, 2018;Woman et al, 2017;Anger et al, 2019;Maged et al, 2019;Amornpetchakul et al, 2018).…”

“…Nesse contexto, os seguintes estudos tiveram como critérios de análise o estágio do trabalho de parto para a realização da intervenção, como resultado da análise, o terceiro estágio do trabalho de parto foi o principal período na realização das intervenções (Rangel et al, 2019;Begley et al, 2019;Salati et al, 2019;Asmat et al, 2017;Quibel et al, 2016;Gallos et al, 2018;Maged et al, 2019;Amornpetchakul et al, 2018).…”

“…Quanto a perda sanguínea das puérperas na hemorragia pós-parto, os seguintes estudos mostraram que o volume variou de ≥500 a ≥2000mL (Begley et al, 2019;Salati et al, 2019;Asmat et al, 2017;Quibel et al, 2016;Suarez et al, 2020;Escobar et al, 2020;Şentürk et al, 2016;Sanad et al, 2018;Gallos et al, 2018;Woman et al, 2017;Maged et al, 2019;Amornpetchakul et al, 2018).…”

“…Um número relativamente pequeno de estudos realizou caracterização sociodemográfica, nos estudos que avaliaram, a faixa etária variou de 18 a 44 anos (Asmat et al, 2017;Şentürk et al, 2016;Sanad et al, 2018;Woman et al, 2017;Anger et al, 2019;Maged et al, 2019;Amornpetchakul et al, 2018).…”

Clinical Significance of Efficiency and Safety of Uterotonics for Obstetric Bleeding Prevention in High Risk Pregnant Women

“…С учетом этого в настоящее время актуален поиск оптимальных и доступных методов профилактики и остановки кровотечений во время и после выполнения операции КС. Перспективным ЛС, применяемым с этой целью, считается карбетоцин -синтетический аналог человеческого окситоцина со структурными модификациями, способствующими удлинению периода его полураспада в организме, что в свою очередь способствует увеличению длительности проявления эффекта препарата в 4-10 раз [10][11][12][13]. Имеющиеся на сегодняшний день результаты исследований позволяют предположить более высокую эффективность карбето-цина, применяемого в качестве ЛС для профилактики послеродовых кровотечений, по сравнению с окситоцином, другими препаратами и их комбинациями [7,12,14].…”