Intravenous Carbetocin to decrease blood loss during open myomectomy: a randomized placebo-controlled study

Hany F. Sallam, Nahla W. Shady


Background: Uterine leiomyomas are benign tumors of the uterus, which represent the most common neoplasms in women of reproductive age, and have a lifetime incidence of approximately 70% in the general population. The objective of this study was to assess the effect of using a single pre-operative dose of IV 100 μg Carbetocin on intra-operative blood loss in abdominal myomectomy surgeries.

Methods: In a randomized double-blind placebo-controlled trial, 86 women undergoing abdominal myomectomy for symptomatic uterine leiomyomas were randomly assigned to receive a single dose of pre-operative of IV 100 μg Carbetocin (n = 43) or placebo (n = 43) just before the operation. The primary outcome was intra-operative blood loss.

Results: Intra-operative blood loss was significantly lower in those women randomized to receive IV Carbetocin versus the placebo group (714.19±186.27 ml versus 1033.49±140.9 ml), p = 0.0001 The incidence of blood transfusion was increased in placebo group (69.8%) compared with (18.6%) in Carbetocin group, (P = 0.0001). Also, there was a significant reduction in operative time in Carbetocin group (66.35%±10.18) compared with placebo group (95.95±9.16), (P = 0.0001).

Conclusions: A single pre-operative dose of IV Carbetocin (100 μg) is a simple applicable method for reducing intra-operative blood loss and operative time in abdominal myomectomy.


Carbetocin, Myomectomy

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Marsh EE, Ekpo GE, Cardozo ER, Brocks M, Dune T, Cohen LS. Racial differences in fibroid prevalence and ultrasound findings in asymptomatic young women (18-30 years old): a pilot study. Fertility and Sterility. 2013;99(7):1951-7.

Taylor A, Sharma M, Tsirkas P, Di Spiezio Sardo A, Setchell M, Magos A. Reducing blood loss at open myomectomy using triple tourniquets: a randomized controlled trial. Br J Obstet Gynaecol. 2005;112:340-5.

Kongnyuy EJ, Wiysonge CS. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev. 2011:Cd005355.

Atashkhoei S, Fakhari S, Pourfathi H, Bilehjani E, Garabaghi PM, Asiaei A. Effect of oxytocin infusion on reducing the blood loss during abdominal myomectomy: a double-blind randomised controlled trial. BJOG. 2016;124:292-8

Busnelli M, Rimoldi V, Vigano P, Persani L, Di Blasio AM, Chini B. Oxytocin-induced cell growth proliferation in human myometrial cells and leiomyomas. Fertil Steril. 2010;94:1869-74.

Agostini A, Ronda I, Franchi F, Bretelle F, Roger V, Cravello L, et al: Oxytocin during myomectomy: a randomized study. Eur J Obstet Gynecol Reprod Biol 2005;118:235-8.

Wang CJ, Lee CL, Yuen LT, Kay N, Han CM, Soong YK. Oxytocin infusion in laparoscopic myomectomy may decrease operative blood loss. J Minim Invasive Gynecol. 2007;14:184-8.

Rath W. Prevention of postpartum hemorrhage with the oxytocin analogue carbetocin. Eur J Obstet Gynecol Reprod Biol. 2009;147(1):15-20.

Sweeney SG, Holbrook AM, Levine M, Yip M, Alfredsson K, Cappi S, et al. Pharmacokinetics of carbetocin, a long-acting oxytocin analogue, in nonpregnant women. Current Therapeutic Research-Clinical and Experimental. 1990;47(3):528-40.

van Dongen PW, Verbruggen MM, de Groot ANJA, van Roosmalen J, Sporken JMJ, Schulz M. Ascending dose tolerance study of intramuscular Carbetocin administered after normal vaginal birth. Eur J Obstet Gynecol Reprod Biol. 1998;77:181-7.

Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in non-gravid women in the reproductive years. Int J Gynaecol Obstet. 2011;113:3-13.

Yang M, Wu C, Wen X, Lin M, Li L. Using Carbetocin to prevent hemorrhage in laparoscopic myomectomy. 2012;6(27):2023-6.

Allah G, Sherine H, Wali A, Mostafa A, Shimaa. Hemostatic effect and postoperative benefits of intramyometrial Carbetocin injection during myomectomy: a randomized controlled trial. Evidence Based Women's Health J. 2015;5(4):185-9.

Su LL, Chong YS, Samuel M. Carbetocin for preventing postpartum haemorrhage. Cochrane Database of Systematic Reviews. 2012;4.

Meshykhi LS, Nel MR, Lucas DN. The role of Carbetocin in the prevention and management of postpartum hemorrhage. Int J Obstet Anesthesia. 2016;28:61-9.

Sweeney G, Holbrook AM, Levine M. Pharmacokinetics of carbetocin, a long-acting oxytocin analogue, in non-pregnant women. Curr Ther Res Clin Exper. 1990;47:528-539

Hunter DJ, Schulz P, Wassenaar W. Effect of carbetocin, a long-acting oxytocin analog on the postpartum uterus. Clin Pharmacol Ther. 1992;52:60-7.

Peters NC, Duvekot JJ. Carbetocin for the prevention of postpartum hemorrhage: a systematic review. Obstet Gynecol Surv. 2009;64(2):129-35.

Engstrom T, Barth T, Melin P, Vilhardt H. Oxytocin receptor binding and uterotonic activity of Carbetocin and its metabolites following enzymatic degradation. Eur J Pharmacol. 1998;355(2-3):203-10.

Rath W. Prevention of postpartum hemorrhage with the oxytocin analogue carbetocin. Eur J Obstet Gynecol Reprod Biol. 2009;147(1):15-20.

Larsson C, Saltvedt S, Wiklund I. Estimation of blood loss after caesarean section and vaginal delivery has low validity with a tendency to exaggeration. Acta Obstet Gynecol Scand. 2006;85:1448-52.

Lee MH, Ingvertsen BT, Kirpensteijn J, Jensen AL, Kristensen AT. Quantification of surgical blood loss. Vet Surg. 2006;35(4):388-93.