The use of uterotonic drugs during caesarean section

Dyer, Robert A.; Dyk, Dominique van; Dresner, Alexandra

doi:10.1016/j.ijoa.2010.04.011

Cited by 84 publications

(75 citation statements)

References 65 publications

(73 reference statements)

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“…A key component of AMTSL is the prophylactic administration of uterotonic drugs after delivery of the fetus, which has shown to reduce the incidence of PPH by 40%. 6 Oxytocin remains the first-line uterotonic drug for both prevention and treatment of PPH; however, it has its own limitations. The half-life of oxytocin is only four to ten minutes; therefore, it requires an infusion for administration.…”

Section: Résumémentioning

confidence: 99%

Carbetocin at Cesarean delivery for labour arrest: a sequential allocation trial to determine the effective dose

Nguyen-Lu

Carvalho

Farine

et al. 2015

Can J Anesth/J Can Anesth

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Purpose The aim of this study was to estimate the effective dose 90% (ED 90 ) of carbetocin to provide adequate uterine tone at Cesarean delivery (CD) for labour arrest. Methods We conducted a double-blind dose-finding study of carbetocin using a biased-coin up-and-down design in women undergoing CD for labour arrest under epidural anesthesia. Forty healthy term pregnant women who had received at least three hours of oxytocin infusion during labour were recruited for the study. Carbetocin was administered intravenously upon delivery of the anterior shoulder of the fetus. The first patient received 20 lg, and the dose for the subsequent patient was determined according to the response of the previous patient as per the biased-coin allocation scheme using increments or decrements of 20 lg (maximum 140 lg). Uterine tone was assessed by the obstetrician and rated as satisfactory or unsatisfactory throughout the intraoperative period. The primary outcome was satisfactory uterine tone with no need for additional uterotonic drugs intraoperatively. Secondary outcomes included use of additional uterotonic drugs postoperatively in the first 24 hr, estimated blood loss, and adverse effects. Results The ED 90 of carbetocin to produce adequate uterine tone was estimated at 121 lg (95% confidence interval [CI]: 111 to 130; 99% CI: 108 to 133) using the truncated Dixon and Mood (DM) method. The isotonic estimator of ED 90 was 140 lg; however, the observed response rate across all doses was \ 90%. Also, the 95% CI of the DM estimator is likely to have lower than expected coverage, while the 99% CI may have about 90% coverage. Therefore, these results should be interpreted with caution. The overall median (range) estimated blood loss was 1,014 (104-2,436) mL. The overall incidence of hypotension and tachycardia were 45% and 57.5%, respectively. At a dose of 140 lg, the incidence of tachycardia and intraoperative arrhythmias was 76% and 14%, respectively. Conclusion The ED 90 of carbetocin at CD for labour arrest, as determined in our study, should be interpreted with caution since it may be underestimated. This dose is higher than the currently recommended dose of 100 lg at elective CD and should not be used routinely given the uncertainty regarding its efficacy and the high incidence of arrhythmias at higher doses. This trial was registered at ClinicalTrials.gov, number: NCT01725243. RésuméObjectif L'objectif de cette étude était d'estimer la dose efficace à 90 % (DE 90 ) de la carbétocine pour atteindre un tonus utérin adapté lors d'un accouchement par césarienne (AC) pour arrêt de la progression du travail. Méthode Nous avons réalisé une étude de détermination de dose de carbétocine à double insu en nous fondant sur une méthodologie biaisée de pile ou face chez des femmes subissant un AC pour arrêt de progression du travail sous anesthésie péridurale. Quarante femmes enceintes en bonne santé et à terme ayant reçu une perfusion d'oxytocine pendant au moins trois heures pendant le travail obstétrical ont été recrutées p...

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Section: Résumémentioning

confidence: 99%

Carbetocin at Cesarean delivery for labour arrest: a sequential allocation trial to determine the effective dose

Nguyen-Lu

Carvalho

Farine

et al. 2015

Can J Anesth/J Can Anesth

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“…[2] Ergometrine has a longer duration of action than oxytocin. [3] Oxytocin A key step in avoiding postpartum haemorrhage (PPH) is ensuring adequate uterine contraction, as this serves to control bleeding from the placental bed naturally.…”

Section: Specific Problems With Uterotonicsmentioning

confidence: 99%

“…This appears to be mediated by calcium-dependent stimulation of nitric oxide release. [3] In animal studies coronary vasoconstriction has been demonstrated. [7] Of concern is the repeated finding of significant reproducible ST depression on the electrocardiogram in pregnant women receiving IV oxytocin boluses.…”

Section: Vasodilation Caused By Oxytocinmentioning

confidence: 99%

“…Cardiac output is increased by an increase in both heart rate and stroke volume. [3] The increase in heart rate and stroke volume protects the majority of women from adverse outcomes, but clearly points to a group who will be especially vulnerable to cardiovascular collapse: those women who cannot achieve an increase in cardiac output. This problem is especially marked in patients who are already hypovolaemic.…”

Section: Vasodilation Caused By Oxytocinmentioning

confidence: 99%

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Oxytocin – ensuring appropriate use and balancing efficacy with safety

Farina

Fawcus

2015

S Afr Med J

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“…Although intramuscular syntometrine is equally effective as intravenous oxytocin 14 , gastrointestinal and cardiovascular side effects such as maternal nausea, vomiting and raised blood pressure 12-14 are more frequent due to stimulation of smooth muscle contraction and vasoconstriction by ergometrine 15,16 . Oral and rectal administration of misoprostol, a synthetic analogue of prostaglandin E1, have demonstrated lower efficacy than injectable uterotonic agents in preventing excessive bleeding following vaginal delivery 17,18 and are associated with a high incidence of shivering, fever and a possible risk of severe hyperthermia 19,20 . These factors deem misoprostol unsuitable for routine prevention of excessive postpartum bleeding in developed countries, despite low cost and ease of use 20,21 .…”

mentioning

confidence: 99%

Carbetocin versus Oxytocin for the Prevention of Postpartum Haemorrhage

Begum

Shaha²,

Mahbuba³

et al. 2016

Faridpur Med Coll J

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Abstract:Postpartum haemorrhage is the leading cause of maternal mortality worldwide. Total 67-80% of cases are caused by uterine atony. Preventive measures include prophylactic drug use to aid uterine contraction after delivery, thus avoiding severe blood loss and reducing maternal morbidity and mortality. Carbetocin is a synthetic analogue of oxytocin with a long half-life which ensure more effective contraction and less adverse effects. It can be administered as a single dose injection either intravenously or intramuscularly rather than as an infusion over several hours as is the case with oxytocin. Carbetocin is currently indicated for prevention of uterine atony after delivery by caesarean section in spinal or epidural anaesthesia. A reduced need for additional uterotonics was observed with carbetocin vs. oxytocin in high-risk women and carbetocin was at least as effective as syntometrine in low-risk women. Carbetocin is effective treatment for the prevention of postpartum haemorrhage not only following caesarean delivery but also after vaginal delivery in high-risk women and those who suffer from hypertensive disorders in pregnancy. Further research is required to assess whether prophylactic carbetocin is superior to conventional uterotonic agents following vaginal delivery in low-risk women.

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The use of uterotonic drugs during caesarean section

Cited by 84 publications

References 65 publications

Carbetocin at Cesarean delivery for labour arrest: a sequential allocation trial to determine the effective dose

Carbetocin at Cesarean delivery for labour arrest: a sequential allocation trial to determine the effective dose

Oxytocin – ensuring appropriate use and balancing efficacy with safety

Carbetocin versus Oxytocin for the Prevention of Postpartum Haemorrhage

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