Preventing postpartum hemorrhage after cesarean delivery: a network meta-analysis of available pharmacologic agents

Jaffer, D.; Singh, Preet Mohinder; Aslam, Adam; Cahill, Alison G.; Palanisamy, Arvind; Monks, David T.

doi:10.1016/j.ajog.2021.08.060

Cited by 29 publications

(11 citation statements)

References 51 publications

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“…A network meta-analysis of accessible pharmacological drugs, which comprised 46 trials and 7368 people, contradicts our results. There was a clinically insignificant quantity of blood loss (54.83 mL; 95 percent confidence interval, 26.48-143.78) in favour of carbotocin over oxytocin, but this difference was not statistically significant [18].…”

Section: Table (1)mentioning

confidence: 85%

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Efficacy of Carbetocin versus Oxytocin and Ergometrin in Prevention of Postpartum Hemorrhage after Cesarean Section

Esseissah

Mohamed

Elnoury

et al. 2022

Benha Journal of Applied Sciences

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Postpartum haemorrhage is defined as blood loss of 500 millilitres or more within 24 hours after a vaginal or c-section birth (WHO 2018). Hypovolemia occurs when more than 1,000mL of blood is lost in the first 24 hours after birth. A postpartum haemorrhage is defined as the loss of more than 1000 ml of blood after a caesarean operation. During and after caesarean surgery, the effectiveness and safety of intravenous carbetocin, an analogue of oxytocin, was compared against intravenous oxytocin and intramuscular ergometrine for the prevention of postpartum haemorrhage. Researchers used a randomised, prospective strategy for the study Researchers at Benha University Hospital's Obstetrics & Gynecology department worked from January 2020 to November 2021. A total of 120 people are taking part in the research. Group A received carbetocin 100g intravenously after the birth of their second child in this trial. Patients in Group B received oxytocin 10IU intravenously and ergometrine 0.02 mg intramuscularly as a combination treatment for 60 patients. Results: Estimated blood loss was significantly different between groups given carbetocin. Carbetocin, rather than oxytocin and ergometrine, is more likely to prevent atonic postpartum haemorrhage in a woman who has had several pregnancies and is undergoing a caesarean section.

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Section: Table (1)mentioning

confidence: 85%

“…According to a network meta-analysis of 46 trials and 7368 people, our findings are incorrect. Just 54.83 mL of predicted blood loss (95 percent confidence range: 26,48-143.78) was shown to be superior than oxytocin, which is clinically insignificant [18].…”

Section: )mentioning

confidence: 89%

Efficacy of Carbetocin versus Oxytocin and Ergometrin in Prevention of Postpartum Hemorrhage after Cesarean Section

Esseissah

Mohamed

Elnoury

et al. 2022

Benha Journal of Applied Sciences

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“…Interestingly, results of initial studies and the first meta-analysis stated that there remained some uncertainty as to the effectiveness of carbetocin 1 but with the growing number of studies, the difference became more obvious and at least 2 recent metaanalyses showed a benefit in favor of carbetocin. 2,3 So, How Can One Explain the Present Results?…”

Section: Commentmentioning

confidence: 94%

Carbetocin Versus Oxytocin Following Vaginal and Cesarean Delivery: A Before-After Study

Tareef¹,

Downey²,

Ma³

et al. 2022

Obstetric Anesthesia Digest

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(Can J Anaesth. 2022;69:97–105) Postpartum hemorrhage increases mortality, morbidity, potential blood transfusion, and length of hospital stay. Usually oxytocin, an effective agent with a short half-life and various possible side effects, is most used to treat postpartum hemorrhage. Carbetocin, though an unpopular method of treatment, has a longer half-life. Because of the shortage of oxytocin in Canada between the months of October and November in 2019, all stakeholders began to use carbetocin. This study researched the difference between carbetocin and oxytocin, especially regarding additional uterotonic medication administration, incidence of postpartum hemorrhage, and blood transfusion rates in a pragmatic before-after study.

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“…Additionally, to our knowledge, there are no cost-effectiveness analyses that directly compared intravenous carbetocin with rectal misoprostol for prevention of PPH during vaginal delivery, and this represents an important focus for future research. Among patients undergoing cesarean delivery, a network meta-analysis of RCTs depicted that carbetocin (not misoprostol) was the most effective uterotonic agent in decreasing postpartum blood loss [ 35 ]. Moreover, among patients undergoing vaginal delivery, a network meta-analysis by Gallos et al [ 36 ] showed that carbetocin was more effective and more costly than all other uterotonic agents including misoprostol.…”

Section: Reviewmentioning

confidence: 99%

Intravenous Carbetocin Versus Rectal Misoprostol for the Active Management of the Third Stage of Labor: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Albazee¹,

Alrashidi²,

Laqwer³

et al. 2022

Cureus

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Globally, postpartum hemorrhage (PPH) is the top cause of maternal death. Multiple uterotonic medications are available to prevent PPH; however, it is still unclear whether one is the most effective. The current study compared the efficacy and safety of intravenous carbetocin with rectal misoprostol for the active management of the third stage of labor in order to prevent PPH. Eligible studies were found utilizing digital medical sources, including the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (WOS), PubMed, Scopus, and Google Scholar, from inception until September 2022. Only randomized controlled trials (RCTs) that matched the inclusion requirements were chosen. We used the Cochrane Risk of Bias scale (version 2) to assess the quality of the included studies. The Review Manager (version 5.4 for Windows) was used to conduct the meta-analysis. The results were summarized as mean difference (MD) or risk ratio (RR) with a 95% confidence interval (CI) in fixed- or random-effects models according to the degree of between-study heterogeneity. Collectively, we screened 621 articles after omitting duplicates and eventually included three RCTs for analysis. Overall, 404 patients were included in these studies; 202 patients were allocated to the intravenous carbetocin group whereas 202 patients were allocated to the rectal misoprostol group. Two RCTs were judged as “low” risk of bias, whereas one RCT was judged as having “some concerns” regarding the quality assessment. Regarding efficacy endpoints, the intravenous carbetocin group had significantly lower blood loss (n=3 RCTs, MD=-117.74 mL, 95% CI [-185.41, -50.07], p<0.001), need for additional uterotonics (n=2 RCTs, RR=0.06, 95% CI [0.01, 0.46], p=0.007), need for uterine massage (n=2 RCTs, RR=0.40, 95% CI [0.20, 0.80], p=0.009), and need for blood transfusion (n=2 RCTs, RR=0.38, 95% CI [0.15, 0.95], p=0.04) compared with the rectal misoprostol group. Regarding safety endpoints, the rates of diarrhea (n=3 RCTs, RR=0.18, 95% CI [0.06, 0.55], p=0.003) and chills (n=2 RCTs, RR=0.31, 95% CI [0.12, 0.83], p=0.02) were significantly lower in the intravenous carbetocin group compared with the rectal misoprostol group. However, there was no significant difference between both groups regarding the rates of headache (n=3 RCTs, RR=1.23, 95% CI [0.06, 1.91], p=0.35) and facial flushing (n=2 RCTs, RR=0.88, 95% CI [0.46, 1.68], p=0.70). In conclusion, it was discovered that intravenous carbetocin was a superior substitute for rectal misoprostol for the active management of the third stage of labor. With far fewer side effects, intravenous carbetocin decreased postpartum blood loss and further uterotonic use. For women who have a high risk of PPH, intravenous carbetocin is advised.

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Preventing postpartum hemorrhage after cesarean delivery: a network meta-analysis of available pharmacologic agents

Cited by 29 publications

References 51 publications

Efficacy of Carbetocin versus Oxytocin and Ergometrin in Prevention of Postpartum Hemorrhage after Cesarean Section

Efficacy of Carbetocin versus Oxytocin and Ergometrin in Prevention of Postpartum Hemorrhage after Cesarean Section

Carbetocin Versus Oxytocin Following Vaginal and Cesarean Delivery: A Before-After Study

Intravenous Carbetocin Versus Rectal Misoprostol for the Active Management of the Third Stage of Labor: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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