Carbetocin versus Oxytocin in placental separation and postpartum haemorrhage in caesarean section-comparative observational study
Keywords:PPH, Uterotonic drugs, Carbetocin, Oxytocin, Lower segment cesarean section
Background: Carbetocin and oxytocin are indicated for the prevention of postpartum haemorrhage (PPH) due to uterine atony. Carbetocin is a newer analogue of oxytocin with longer half life and more heat stable. PPH can be effectively reduced by the prophylactic use of uterotonics. The aims of the present study were to compare effects of oxytocin and carbetocin in separation of placenta, in controlling the blood loss and the additional uterotonic needed in caesarean section (CS) at high risk of primary PPH.
Methods: Women in the carbetocin group (group A) received a bolus of 100 µg IV; women in the control group (group B) received 20 IU of oxytocin in 1000 ml of 0.9% NaCl solution IV (150 mL/ hour). The efficacy of drugs in controlling blood loss was evaluated. Also, the haemodynamic effects and the need for additional uterotonic agents was compared. In addition, we compared the drop in haemoglobin level, the placental separation, the uterine tone.
Results: Both drugs produce hypotension but the effect was greater in oxytocin group. Placental separation was seen early in oxytocin group. Uterine tone was attained earlier in oxytocin group however the tone was maintained persistently in carbetocin group. Additional uterotonic agents were needed in the oxytocin group (46% vs 0%, p=0.05).
Conclusions: A single injection of carbetocin appears to be more effective than a continuous infusion of oxytocin to maintain sustained and adequate uterine tone and to prevent the PPH. However, there is delayed placental separation and delayed attainment of adequate uterine tone after use of carbetocin.
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