The effect of carbetocin compared to misoprostol in management of the third stage of labor and prevention of postpartum hemorrhage: a systematic review

Abstract

BackgroundPostpartum hemorrhage (PPH) and the amount of blood loss are directly related to management of the third stage of labor. No previous report has compared the effects of carbetocin to those of misoprostol. The aim of this systematic review was to compare the effects of carbetocin to those of misoprostol for management of the third stage of labor and for the prevention of PPH.MethodsWe searched the Cochrane Library (Central), Web of Science, Scopus, Science Direct, Ovid, clinicaltrial.gov, and PubMed databases on December 28, 2017. Data extraction and risk of bias assessment were performed by 2 of the authors independently. Individual and pooled incidences were calculated for the included studies, with 95% confidence intervals (CIs). We used a fixed model for forest plots without heterogeneity and a random effect model for those with heterogeneity.ResultsOur search identified 117 studies; however, 29 studies were duplicate. Of the 88 non-duplicate studies, 5 met the inclusion criteria. Of these five studies, two are currently underway. Hence, three studies were finally included in our meta-analysis. The pooled estimate of the impact of carbetocin on PPH (500–1000 ml) was (OR 0.27, 95% CI 0.14–0.50). Carbetocin significantly reduced the need for additional uterotonics (RR 0.28, 95% CI 0.15 to 0.49). Reduction in the hemoglobin level and blood loss during the third stage of labor was significantly lower in women who received carbetocin than in those who received misoprostol. The length of the third stage of labor was significantly lower in women who received carbetocin than in those who received misoprostol. The incidence of side effects, such as heat sensation, metallic taste, fever, and shivering, were significantly lower in women who received carbetocin than in those who received misoprostol.ConclusionAlthough this review showed that carbetocin is effective for decreasing PPH, blood loss, the length of the third stage of labor, and the need for additional uterotonics, this conclusion should be considered with caution. Because assessment of PPH is a subjective issue and it is uncertain whether outcomes were assessed blindly in respect to treatment. We recommend future research to verify our findings. Also clinicians may like to consider use of carbetocin for women with low risk for PPH.Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0832-4) contains supplementary material, which is available to authorized users.

Carbetocin versus Rectal Misoprostol to Decrease Blood Loss in Vaginal Delivery in High Risk Patients for Postpartum Hemorrhage

“…In current study, the amount of blood loss was significantly less in the Carbetocin group [364.79 ± 40.99 cc] than in misoprostol group [404.68 ± 67.24 cc] [p-value = 0.001]. This is coincided with the results done by Abd El Aziz et al [15] ; the results revealed that blood loss was significantly lower in carbetocin than misoprostol groups among females delivered through normal vaginal delivery [NVD] and those delivered by cesarean section.…”

“…The results showed that the hemoglobin was not significantly different between women who received carbetocin or misoprostol among women who had normal vaginal delivery. However, the hemoglobin levels were significantly reduced in misoprostol than carbetocin among females delivered by cesarean section [15] . In the same line, Attilakos et al [16] compared carbetocin and oxytocin: the results were not significant different and there was no difference in the mean hemoglobin after delivery.…”

“…The results of different studies regarding side effects of drugs used to prevent PPH shows many conflicts and not consistent with each other. For instance, Abd El-Aziz et al [15] stated that regarding side effects of drugs used to prevent PPH; the heart rate was higher in misoprostol than carbetocin. Additionally, the incidence of heat sensation, metallic taste, fever, and shivering were significantly higher in misoprostol than carbetocin.…”

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

“…These findings align with Abd El Aziz et al [ 27 ] and Hetiba et al [ 25 ], who found that blood loss was substantially lower in the intravenous carbetocin arm compared with the misoprostol arm among women who gave birth vaginally or via cesarean surgery. Also, when misoprostol, oxytocin, and carbetocin were tested in a study by Mousa et al [ 10 ], the average blood loss was substantially higher in the misoprostol arm than in the carbetocin arm.…”

“…Because of numerous variables related to population research designs and population characteristics, the results of various studies on the side effects of medications used to prevent PPH reveal many discrepancies and are incompatible with one another. For example, Abd El-Aziz et al [ 27 ] reported that misoprostol had a greater heart rate and heat feeling than carbetocin in terms of adverse effects. Additionally, Ibrahim and Saad [ 30 ] published the findings on adverse effects, finding that carbetocin was more frequently linked to nausea, vomiting, and headache.…”