Randomized controlled trial comparing carbetocin, misoprostol, and oxytocin for the prevention of postpartum hemorrhage following an elective cesarean delivery

Elbohoty, Ahmed; Mohammed, Walid E.; Sweed, Mohamed S.; El-Din, Ahmed Mohamed Bahaa; Nabhan, Ashraf; Abd-El-Maeboud, Karim H. I.

doi:10.1016/j.ijgo.2016.01.025

Cited by 31 publications

(45 citation statements)

References 23 publications

(38 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Adverse effects such as heat sensation, metallic taste, fever, and shivering were all highest in misoprostol group (p <0.05). 7 These findings are in accordance with another study by Ibrahim et al in 2017 that compares the use of 100 μg of intravenous carbetocin with 600 μg of sublingual misoprostol for prevention of PPH in women with severe preeclampsia following vaginal delivery. 60 women were recruited, 30 in each group.…”

Section: Carbetocin Versus Misoprostolsupporting

confidence: 91%

“…3,5,16 Uterotonic agents that currently available for preventing PPH are oxytocin, carbetocin, methylergometrine, syntometrine, misoprostol and carboprost. 7 Pharmacology of these drugs is shown in Table 1.…”

Section: Etiologymentioning

confidence: 99%

“…1 Several studies have reported that carbetocin decreases the need for additional uterotonic agents compared to oxytocin. 7,10,11 Moreover, studies from Reyes et al and Nucci et al showed that carbetocin had similar safety profile with oxytocin in preventing PPH in women with severe preeclampsia. 12,13 Therefore, the author is interested to write this review article to compare the efficacy of carbetocin with other uterotonic agents in preventing postpartum hemorrhage using recent evidence.…”

Section: Introductionmentioning

confidence: 97%

“…It acts by enhancing natural uterine contraction and retraction during third stage of labour. 7 Uterotonic agents that currently available are oxytocin, carbetocin, ergot alkaloids (such as ergonovine, syntometrine) and prostaglandins (such as misoprostol, carboprost). 1,8,9 The most commonly used uterotonic agent for prevention of PPH is oxytocin.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Comparison of carbetocin with other uterotonic agents in preventing postpartum hemorrhage

Carlisa¹

2018

Int J Reprod Contracept Obstet Gynecol

View full text Add to dashboard Cite

Postpartum hemorrhage (PPH) is defined as blood loss of at least 500 ml or more after vaginal delivery and 1000 ml or more after abdominal delivery. It contributes up to 28% of maternal mortality worldwide and 30.3% of maternal death in Indonesia. 70% cases of PPH are caused by uterine atony. PPH can be prevented by doing routine use of uterotonic agents in active management of third stage of labour. Uterotonic agents that currently available are oxytocin, carbetocin, methylergometrine, syntometrine, misoprostol and carboprost. Carbetocin (a long-acting synthetic analogue of oxytocin) is a new drug which has stronger ability to induce uterine contraction than oxytocin. It does not induce hypertension like methylergometrine and syntometrine. Therefore, carbetocin can be considered as an alternative drug to oxytocin in women with severe preeclampsia. However, more studies are needed to assess the efficacy and safety of carbetocin for prevention of PPH in preeclamptic women. Compared to methylergometrine and syntometrine, carbetocin is more effective in reducing postpartum blood loss. Adverse effects like nausea and vomiting were lower in women treated with carbetocin. Compared to misoprostol, carbetocin is also superior in reducing blood loss. Adverse effects like shivering, fever and metallic taste were higher in women treated with misoprostol. Further studies are needed to assess the superiority between carbetocin and carboprost since there is no published literature yet regarding this topic. In conclusion, carbetocin is superior to other uterotonic agents in preventing postpartum hemorrhage with fewer adverse effects.

show abstract

Section: Carbetocin Versus Misoprostolsupporting

confidence: 91%

Section: Etiologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of carbetocin with other uterotonic agents in preventing postpartum hemorrhage

Carlisa¹

2018

Int J Reprod Contracept Obstet Gynecol

View full text Add to dashboard Cite

show abstract

“…We used the dosing scheme (and the PPH risk) described by Borruto et al 22 and Attilakos et al 23 because they included women with at least one risk factor for PPH. In other studies, using even higher doses of oxytocin, [26][27][28][29] the risk reduction with carbetocin was even greater; however, there are differences in the characteristics of the population, particularly related to the level of risk that does not allow to clearly observe the differences between alternatives, so it was preferred to adopt a conservative scenario. Regarding utility values, these were based on international studies, since there are no quality of life studies available in our country, and these may not necessarily reflect the preferences of Colombian patients.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of Carbetocin versus Oxytocin for Prevention of Postpartum Hemorrhage Resulting from Uterine Atony in Women at high-risk for bleeding in Colombia

Gil-Rojas

Lasalvia

Hernández

et al. 2018

Rev Bras Ginecol Obstet

View full text Add to dashboard Cite

Objective To assess the cost-effectiveness of carbetocin versus oxytocin for prevention of postpartum hemorrhage (PPH) due to uterine atony after vaginal delivery/ cesarean section in women with risk factors for bleeding. Methods A decision tree was developed for vaginal delivery and another one for cesarean, in which a sequential analysis of the results was obtained with the use of carbetocin and oxytocin for prevention of PPH and related consequences. A third-party payer perspective was used; only direct medical costs were considered. Incremental costs and effectiveness in terms of quality-adjusted life years (QALYs) were evaluated for a one-year time horizon. The costs were expressed in 2016 Colombian pesos (1 USD ¼ 3,051 Col$). Results In the vaginal delivery model, the average cost of care for a patient receiving prophylaxis with uterotonic agents was Col$ 347,750 with carbetocin and Col$ 262,491 with oxytocin, while the QALYs were 0.9980 and 0.9979, respectively. The incremental costeffectiveness ratio is above the cost-effectiveness threshold adopted by Colombia. In the model developed for cesarean section, the average cost of a patient receiving prophylaxis with uterotonics was Col$ 461,750 with carbetocin, and Col$ 481,866 with oxytocin, and the QALYs were 0.9959 and 0.9926, respectively. Carbetocin has lower cost and is more effective, with a saving of Col$ 94,887 per avoided hemorrhagic event. Conclusion In case of elective cesarean delivery, carbetocin is a dominant alternative in the prevention of PPH compared with oxytocin; however, it presents higher costs than oxytocin, with similar effectiveness, in cases of vaginal delivery.

show abstract

Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis

Gallos

Williams

Price

et al. 2018

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Ergometrine plus oxytocin combination, carbetocin, and misoprostol plus oxytocin combination were more effective for preventing PPH ≥ 500 mL than the current standard oxytocin. Ergometrine plus oxytocin combination was more effective for preventing PPH ≥ 1000 mL than oxytocin. Misoprostol plus oxytocin combination evidence is less consistent and may relate to different routes and doses of misoprostol used in the studies. Carbetocin had the most favourable side-effect profile amongst the top three options; however, most carbetocin trials were small and at high risk of bias.Amongst the 11 ongoing studies listed in this review there are two key studies that will inform a future update of this review. The first is a WHO-led multi-centre study comparing the effectiveness of a room temperature stable carbetocin versus oxytocin (administered intramuscularly) for preventing PPH in women having a vaginal birth. The trial includes around 30,000 women from 10 countries. The other is a UK-based trial recruiting more than 6000 women to a three-arm trial comparing carbetocin, oxytocin and ergometrine plus oxytocin combination. Both trials are expected to report in 2018.Consultation with our consumer group demonstrated the need for more research into PPH outcomes identified as priorities for women and their families, such as women's views regarding the drugs used, clinical signs of excessive blood loss, neonatal unit admissions and breastfeeding at discharge. To date, trials have rarely investigated these outcomes. Consumers also considered the side-effects of uterotonic drugs to be important but these were often not reported. A forthcoming set of core outcomes relating to PPH will identify outcomes to prioritise in trial reporting and will inform futures updates of this review. We urge all trialists to consider measuring these outcomes for each drug in all future randomised trials. Lastly, future evidence synthesis research could compare the effects of different dosages and routes of administration for the most effective drugs.

show abstract

Randomized controlled trial comparing carbetocin, misoprostol, and oxytocin for the prevention of postpartum hemorrhage following an elective cesarean delivery

Abstract: Additional uterotonics were needed less frequently by patients treated with carbetocin. Carbetocin was comparable to oxytocin and superior to misoprostol in the prevention of uterine atony following an elective cesarean delivery. ClinicalTrials.gov: NCT02053922.

Cited by 31 publications

References 23 publications

Comparison of carbetocin with other uterotonic agents in preventing postpartum hemorrhage

Comparison of carbetocin with other uterotonic agents in preventing postpartum hemorrhage

Cost-effectiveness of Carbetocin versus Oxytocin for Prevention of Postpartum Hemorrhage Resulting from Uterine Atony in Women at high-risk for bleeding in Colombia

Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis

Contact Info

Product

Resources

About