Carbetocin versus Oxytocin and Misoprostol in prevention of atonic post-partum hemorrhage in high risk patients planed for cesarean delivery

Authors

  • Abd El-Naser Abd El-Gaber Ali Department of Obstetrics and Gynecology, Faculty of Medicine South Valley, University, Egypt
  • Ahmed Ali M. Nasr Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Egypt
  • Hazem H. Ahmed Department of Obstetrics and Gynecology, Faculty of Medicine South Valley, University, Egypt
  • Mahmoud I. El- Rasheedy Department of Obstetrics and Gynecology, Faculty of Medicine South Valley, University, Egypt
  • Mahmoud Badawy Department of Obstetrics and Gynecology, Faculty of Medicine South Valley, University, Egypt

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20175824

Keywords:

Carbetocin, Cesarean section, Misoprostol, Oxytocin, Postpartum hemorrhage

Abstract

Background: Post-partum hemorrhage prevention (PPH) is considered a major issue due to its effect on maternal morbidity and mortality. The objective of this study was to compare efficacy of Carbetocin in prevention of atonic post-partum hemorrhage in high risk patients undergoing elective caesarean section in comparison to Oxytocin and Misoprostol.

Methods: 150 pregnant women prepared for elective caesarean section were classified into 3 groups; Group I (50 patients received Carbetocin 100 mg I.V infusion), Group II (50 patients received 20 IU of Oxytocin infusion on 1000 ml of normal saline solution) and Group III (50 cases received Misoprostol 400 µg per rectum immediately before induction of anaesthesia). Assessment of PPH and its degree was determined according to amount of blood loss during and for first 24 hours of caesarean delivery, also further need for haemostatic measures were also assessed.

Results: There was a statistically significant difference in PPH among the three groups 6, 14 and 12% for group I, II and III respectively (P <0.001), major PPH was 0, 4 and 6% for the same groups respectively (P <0.001). The need for additional uterotonic agents was significantly lesser in Group I compared to Group II and III (2% versus 8 and 12% respectively P = 0.02) also the need for additional surgical measures was significantly lesser among the three groups (P= 0.00). The drop in Hb level and haematocrit value was significantly lesser in group I compared to group II& III (P <0.05). The need for blood transfusion was significantly lesser in Group I compared to group II and III (0% versus 12% p <0.0001)

Conclusions: Carbetocin was superior to Oxytocin and Misoprostol in prevention of atonic PPH in high risk patients underwent elective caesarean delivery. Carbetocin should be administered for all cases undergoing elective CS and carry a risk factor for postpartum hemorrhage.

 

References

Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol. 2008;22:999e1012.

Begley CM, Gyte GM, Devane D, Mcguire W, Weeks A. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev. 2011;11:CD007412.

Mousa HA, Alfirevic Z. Treatment for primary postpartum haemorrhage. Cochrane Database of Systematic Reviews. 2007;1:CD003249.

Anderson JM, Etches D. Prevention and management of postpartum hemorrhage. Am Fam Physician. 2007;75:875e82.

Sheldon WR, Blum J, Vogel JP, Souza JP, Gülmezoglu AM, Winikoff B. WHO multicountry survey on maternal and newborn health research network. postpartum hemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014;121:S5e13.

Leduc, Leduc D, Senikas V, Lalonde AB, Ballerman C, Biringer A, et al. Active management of the thirdstage of labour: prevention and treatment of postpartum hemorrhage. J Obstet Gynaecol Canada JOGC. 2009;31(10):980-93.

Ramanathan G, Arulkumaran S. Postpartum haemorrhage. Curr Obstet Gynaecol. 2006;16:6-13.

Peters NCJ, Duvekot JJ. Carbetocin for the prevention of postpartum hemorrhage: a systematic review. Obstet Gynecol Surv. 2009;64:129-35.

Chen CY, Su YN, Lin TH, Chang Y, Horng HC, Wang PH, et al. Carbetocin in prevention of postpartum hemorrhage: experience in a tertiary medical center of Taiwan. Taiwanese J Obstet Gynecol. 2016;55(6):804-9.

Atke A, Vilhardt H. Uterotonic activity and myometrial receptor affinity of 1-deamino-1-carba-2-tyrosine (Omethyl)-Oxytocin. Acta Endocrinol (Copenh). 1987;115:155-60

Leung SW, Ng PS, Wong WY, Cheung TH. A randomized trial of Carbetocin versus syntometrine in the management of the third stage of labour. BJOG. 2006;113:1459-64.

Rath W. Prevention of postpartum hemorrhage with the Oxytocin analogue Carbetocin. Eur J Obstet Gynecol Reprod Biol. 2009;147:15-20

Moran C, Bhuinneain NM, Geary M, Cunningham S, Mckenna P, Gardiner J. Myocardial ischaemia in normal patients undergoing elective Caesarean section: a peripartum assessment. Anaesthesia. 2001;56:1051-8.

Alfirevic Z, Blum J, Walraven G, Weeks A, Winikoff B. Prevention of postpartum hemorrhage with Misoprostol. Int J Gynecol Obstet. 2007;99(2):S198-201.

Mousa HA, Blum J, Abou El Senoun G, Shakur H, Alfirevic Z. Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev. 2014;2:CD003249.

Hazra S, Chilaka V, Rajendrans. Massive postpartum hemorrhage as a cause of maternal morbidity in large tertiary hospital. J Obstet Gynecol; 2004;24:519-20.

Dansereau J, Joshi AK, Helewa ME. Double-blind comparison of Carbetocin versus Oxytocin in prevention of uterine atony after cesarean section. Am J Obstet Gynecol. 1999;180:670-6.

Larciprete G, Montagnoli C, Frigo M, Panetta V, Todde C, Zuppani B, et al. Carbetocin versus oxytocin in caesarean section with high risk of post-partum hemorrhage. J Prenatal Med. 2013;7(1):12.

Boucher M, Horbay GL, Griffin P, Deschamps Y, Desjardins C, Schulz M, et al. Double-blind randomized comparison of the effect of Carbetocin and Oxytocin on intraoperative blood loss and uterine tone of patients undergoing cesarean section. J Perinatol. 1998;18:202-7.

Borruto F, Treisser A, Comparetto C. Utilization of Carbetocin for prevention of postpartum hemorrhage after cesarean section: a randomized clinical trial. Arch Gynecol Obstet. 280:707-12.

Downloads

Published

2017-12-25

Issue

Section

Original Research Articles