The maternal cardiovascular effect of carbetocin compared to oxytocin in women undergoing caesarean section

Pisani, I.; Tiralongo, G.; Gagliardi, G.; Scala, R.L.; Todde, C.; Frigo, Maria Grazia; Valensise, H.

doi:10.1016/j.preghy.2012.01.002

Cited by 15 publications

(11 citation statements)

References 8 publications

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“…20 Carbetocin, a synthetic derivate of oxytocin but with a longer half-life (median terminal elimination half-life is 33 minutes after intravenous administration and 55 minutes after intramuscular administration 7 ) shows similar haemodynamic effects to oxytocin. [11][12][13] Like oxytocin, carbetocin binds to the oxytocin receptor therefore affects the same tissues. 7 Oxytocin has been shown to increase cardiac output by decreasing vascular tone in small and peripheral arteries, resulting in a lower blood pressure and a compensatory increase in heart rate, implying increased myocardial oxygen demand.…”

Section: Discussionmentioning

confidence: 99%

“…7 The efficacy is documented in several randomized controlled trials and meta-analyses. 5,[8][9][10] Although both oxytocin and carbetocin have similar haemodynamic effects, [11][12][13] there is insufficient evidence of their effects on the myocardium. Cardiac troponin I is a protein that is released by myocardial myocytes when starved of oxygen and can be used as an indirect measure of ischaemic heart damage.…”

Section: Introductionmentioning

confidence: 99%

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A study protocol for the cardiac effects of a single dose of either oxytocin 2.5 IU or carbetocin 100 µg after caesarean delivery: a prospective randomized controlled multi-centre trial in Norway

et al. 2021

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Background: Both oxytocin and carbetocin are used to prevent uterine atony and post-partum haemorrhage after caesarean delivery in many countries, including Norway. Oxytocin causes dose-dependent ST-depression, troponin release, prolongation of QT-time and arrythmia, but little is known about myocardial effects of carbetocin. We have previously demonstrated comparable vasodilatory effects of oxytocin and carbetocin and are now undertaking a Phase 4 trial to investigate whether carbetocin causes similar changes to myocardial markers compared with oxytocin. Methods: Our randomized controlled trial will be conducted at three obstetrics units at Oslo University Hospital and Akershus University Hospital, Norway. Planned enrolment will be of 240 healthy, singleton pregnant women aged 18 to 50 years undergoing planned caesarean delivery. Based on pilot study data, each participant will receive a one-minute intravenous injection of either oxytocin 2.5 IU or carbetocin 100 µg during caesarean delivery. The prespecified primary outcome is the change from baseline in high-sensitive troponin I plasma concentrations at 6–10 hours after study drug administration. Secondary outcomes include uterine tone grade at 2.5 and five minutes after study drug administration, adverse events for up to 48 hours after study drug administration, estimated blood loss within eight hours of delivery, need for rescue treatment and direct/indirect costs. Enrolment and primary analysis are expected to be completed by the end of 2021. Discussion: Women undergoing caesarean delivery should be assessed for cardiovascular risk particularly as women with an obstetric history of pregnancy induced hypertension, gestational diabetes mellitus, preterm birth, placental abruption, and stillbirth are at increased risk of future cardiovascular disease. Any additional ischaemic myocardial risk from uterotonic agents will need to be balanced with the benefit of reducing the risk of postpartum haemorrhage. Any potential cardiotoxicity difference between oxytocin and carbetocin will help inform treatment decisions for pregnant women. Registration: Clinicaltrials.gov NCT03899961 (02/04/2019).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A study protocol for the cardiac effects of a single dose of either oxytocin 2.5 IU or carbetocin 100 µg after caesarean delivery: a prospective randomized controlled multi-centre trial in Norway

et al. 2021

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“…Recently a new device has been introduced for the measurement of SV and CO in pregnancy, the UltraSonic Cardiac Output Monitor (USCOM 1A®). This is a non‐invasive hemodynamic monitor that measures cardiovascular values by using a non‐imaging continuous‐wave Doppler transducer placed on the suprasternal notch to determine ascending transaortic blood flow (Figure ).…”

Section: Methods Of Co Measurementmentioning

confidence: 99%

Methods and considerations concerning cardiac output measurement in pregnant women: recommendations of the International Working Group on Maternal Hemodynamics

Bijl

Valensise

Novelli³

et al. 2019

Ultrasound in Obstet & Gyne

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Cardiac output (CO), along with blood pressure and vascular resistance, is one of the most important parameters of maternal hemodynamic function. Substantial changes in CO occur in normal pregnancy and in most obstetric complications. With the development of several non‐invasive techniques for the measurement of CO, there is a growing interest in the determination of this parameter in pregnancy. These techniques were initially developed for use in critical‐care settings and were subsequently adopted in obstetrics, often without appropriate validation for use in pregnancy. In this article, methods and devices for the measurement of CO are described and compared, and recommendations are formulated for their use in pregnancy, with the aim of standardizing the assessment of CO and peripheral vascular resistance in clinical practice and research studies on maternal hemodynamics. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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“…A non-imaging continuous-wave Doppler transducer was placed at the suprasternal notch to measure transaortic blood flow. After manual entry of the patient's weight and height, the device computed cardiac output from the velocity time integral of the blood flow through the aortic valve [23]. Blood pressure was measured separately (Logiko Digit Device, Moretti S.p.A., Cavriglia, Italy) and then added to the algorithm for the automatic calculation of peripheral vascular resistance.…”

Section: Cardiovascular Assessmentmentioning

confidence: 99%

Maternal Cardiovascular Dysfunction is Associated with Hypoxic Cerebral and Umbilical Doppler Changes

Masini

Tay

McEniery

et al. 2020

JCM

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We investigate the relationship between maternal cardiovascular (CV) function and fetal Doppler changes in healthy pregnancies and those with pre-eclampsia (PE), small for gestational age (SGA) or fetal growth restriction (FGR). This was a three-centre prospective study, where CV assessment was performed using inert gas rebreathing, continuous Doppler or impedance cardiography. Maternal cardiac output (CO) and peripheral vascular resistance (PVR) were analysed in relation to the uterine artery, umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PI, expressed as z-scores by gestational week) using polynomial regression analyses, and in relation to the presence of absent/reversed end diastolic (ARED) flow in the UA. We included 81 healthy controls, 47 women with PE, 65 with SGA/FGR and 40 with PE + SGA/FGR. Maternal CO was inversely related to fetal UA PI and positively related to MCA PI; the opposite was observed for PVR, which was also positively associated with increased uterine artery impedance. CO was lower (z-score 97, p = 0.02) and PVR higher (z-score 2.88, p = 0.02) with UA ARED flow. We report that maternal CV dysfunction is associated with fetal vascular changes, namely raised impedance in the fetal-placental circulation and low impedance in the fetal cerebral vessels. These findings are most evident with critical UA Doppler changes and represent a potential mechanism for therapeutic intervention.

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The maternal cardiovascular effect of carbetocin compared to oxytocin in women undergoing caesarean section

Cited by 15 publications

References 8 publications

A study protocol for the cardiac effects of a single dose of either oxytocin 2.5 IU or carbetocin 100 µg after caesarean delivery: a prospective randomized controlled multi-centre trial in Norway

A study protocol for the cardiac effects of a single dose of either oxytocin 2.5 IU or carbetocin 100 µg after caesarean delivery: a prospective randomized controlled multi-centre trial in Norway

Methods and considerations concerning cardiac output measurement in pregnant women: recommendations of the International Working Group on Maternal Hemodynamics

Maternal Cardiovascular Dysfunction is Associated with Hypoxic Cerebral and Umbilical Doppler Changes

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