CARBETOCIN FOR PREVENTING POSTPARTUM HAEMORRHAGE PDF

J Matern Fetal Neonatal Med. Epub Sep 4. Carbetocin for the prevention of postpartum hemorrhage: a systematic review and meta-analysis of randomized controlled trials. However, with respect to postpartum hemorrhage, severe postpartum hemorrhage, mean estimated blood loss and adverse effects, our analysis failed to detect a significant difference. Studies comparing carbetocin with syntometrine in women undergoing vaginal delivery demonstrated no statistical difference in terms of risk of postpartum hemorrhage, severe postpartum hemorrhage or the need for additional uterotonic agents, but the risk of adverse effect was significantly lower in the carbetocin group.

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Summary Objectives the aims of the present study were to compare the haemodynamic effects of oxytocin and carbetocin and to assess the efficacy of these two drugs in terms of blood loss and the additional uterotonic needed in caesarean section at high risk of primary post-partum haemorrhage. The main parameter evaluated was the haemodynamic effects of drugs and the need for additional uterotonic agents.

In addition we compared the drop in haemoglobin level, the uterine tone, the uterine fundal state and the diuresis. Results regarding the haemodynamic effects, both drugs have a hypotensive effect, but we found a greater reduction in blood pressure within the oxytocin group. Conclusions a single injection of carbetocin appears to be more effective than a continuous infusion of oxytocin to prevent the PPH, with a similar haemodynamic profile and minor antidiuretic effect.

Keywords: post-partum haemorrhage, uterotonic drugs, carbetocin, oxytocin Introduction Prevention of post-partum haemorrhage PPH is a major issue due to its impact on maternal morbidity and mortality.

The primary PPH is defined as blood loss more than mL after vaginal delivery and more than mL after caesarean section, that occurs in the first 24 hours after delivery. Almost The study conducted by the International PPH Collaborative Group reports an increasing trend in coded PPH between and not only in low income countries, but also in Canada, New South Wales and the USA, as a possible result of increased maternal age at childbirth, increased rate of caesarean delivery, increased rate of induction of labor and higher number of multiple pregnancies 2.

The first cause of haemorrhage at the time of delivery is uterine atony, therefore there is general agreement that active management of the third stage of labour rather than expectant management is recommended 2 — 4. The third stage of labor is defined as the period that follows delivery and finishes with the delivery of placenta.

The practical guidelines on PPH of the Society of Obstetricians and Gynaecologists of Canada SOGC 5 suggest that the active management of the third stage of labour reduces the risk of PPH compared with the expectant management and should be offered and recommended to all women.

The administration of uterotonic drugs widely prevents the PPH, significantly decreases the incidence of PPH and therefore it is the main point of active management. Oxytocin 10 IU , administered intra-muscularly, is the preferred medication for the prevention of PPH in low-risk vaginal and caesarean deliveries.

Care providers should administer this medication after delivery of the anterior shoulder. Ergonovine can be used but it may be considered a second choice to oxytocin due to the greater risk of maternal adverse effects. Although the oxytocin is the most widely accepted uterotonic agent, however other drugs are available, but which agent is ideal for prophylactic use is far to be clearly stated 5.

Carbetocin is a long-acting synthetic oxytocin analogue, 1-deaminomonocarbo- 2-O-Methyltyrosine -oxytocin, firstly described in A single dose of carbetocin has been hypothysed to act as a 16 hours intravenous oxytocin infusion regarding the increase in uterine tone and the reduction of the risk of PPH in elective caesarean section 7.

Several data of literature 8 — 10 suggest that prophylactic administration of carbetocin may be a good alternative to oxytocin to prevent post-partum haemorrhage, but which uterotonic agent is ideal for prophylactic use is being debated.

Nonetheless, primary prevention of a post-partum haemorrhage begins with the assessment of identifiable risk factors. The aims of the present study were: - to compare the haemodynamic effects of oxytocin and carbetocin effects on blood pressure and diuresis - to assess the efficacy of these two drugs in terms of intra-operative blood loss and the additional uterotonic needed in caesarean section at high risk of post-partum haemorrhage.

Methods This is a prospective, case-control study conducted from July and October within the Obstetric and Gynaecology tertiary care unit of Fatebenefratelli Isola Tiberina, Rome. One hundred two women undergoing elective caesarean section were consecutively enrolled, with risk factors for primary post-partum haemorrhage such as: multiple pregnancy, two or more previous caesarean section, presence of uterine fibroids, previous myomectomy, presence of placenta previa, past history of PPH, fetal macrosomia and fetal malformations associated with polyhydramnios.

A written informed consent was asked from eligible women on admission. The exclusion criteria included the presence of hypertension, preeclampsia, cardiac, renal or liver diseases, epilepsy and general anaesthesia, as well as women with history of hypersensitivity to carbetocin according to the Br National Formulary 8.

Firstly we recruited fifty-one women who received carbetocin case group A , then we enrolled fifty-one women who received oxytocin control group B. The primary outcome of this study was the evaluation of the early haemodynamic effects of carbetocin and oxytocin, in terms of impact on the blood pressure BP suddenly after the injection.

All patients underwent the same combined spinal-epidural CSE anaesthesia. To evaluate the haemodynamic effects between carbetocin and oxytocin we considered the drop in a blood pressure comparing the BP after combined spinal-epidural CSE procedure, 1 minute, 3 minutes and 5 minutes after drug administration, at time of uterine repair and at term of caesarean procedure, on left recumbent position.

We recorded the occurrence of nausea, vomiting, flushing, haedache, dyspnea and tachycardia. The latter important outcome of this study was the need for additional uterotonic agents and the evaluation of the drop in haemoglobin level by comparing the haemoglobin concentration on admission with the measure at 2 hours and 24 hours after delivery.

Also the blood loss is checked immediately after caesarean, defining as haemorrhage a blood loss in excess of ml or more 5. Blood loss was estimated by the surgeon in the usual way visual estimation, number of used swabs and amount of aspirated blood 8. Blood pressure in mmHg , uterine tone standardized as Very good, Good, Sufficient, Atony , uterine position with respect to the umbilical point, UP were monitored 2 hours, 12 hours and 24 hours after delivery by the same midwife.

All patients had the Foley catheter and urobag in situ for 24 hours after caesarean section and the amount of urine was monitored 2 hours and 12 hours after delivery by the midwife.

This study had no external funding source. No author had any potential relationships that may pose conflict of interest. Data were tested for normal distribution.

Table 1 Characteristics of the study population.

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Use of carbetocin for preventing postpartum hemorrhage

Summary Objectives the aims of the present study were to compare the haemodynamic effects of oxytocin and carbetocin and to assess the efficacy of these two drugs in terms of blood loss and the additional uterotonic needed in caesarean section at high risk of primary post-partum haemorrhage. The main parameter evaluated was the haemodynamic effects of drugs and the need for additional uterotonic agents. In addition we compared the drop in haemoglobin level, the uterine tone, the uterine fundal state and the diuresis. Results regarding the haemodynamic effects, both drugs have a hypotensive effect, but we found a greater reduction in blood pressure within the oxytocin group. Conclusions a single injection of carbetocin appears to be more effective than a continuous infusion of oxytocin to prevent the PPH, with a similar haemodynamic profile and minor antidiuretic effect. Keywords: post-partum haemorrhage, uterotonic drugs, carbetocin, oxytocin Introduction Prevention of post-partum haemorrhage PPH is a major issue due to its impact on maternal morbidity and mortality. The primary PPH is defined as blood loss more than mL after vaginal delivery and more than mL after caesarean section, that occurs in the first 24 hours after delivery.

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Carbetocin for preventing postpartum haemorrhage

Coronavirus COVID resources Carbetocin for preventing postpartum haemorrhage In low- and middle-income countries, postpartum haemorrhage is a major cause of maternal deaths and ill health. In high-income countries, the problems are much less but there is still a small risk of major bleeding problems for women after giving birth. Active management of the third stage of labour, which is generally used to reduce blood loss at birth, consists of giving the mother a drug that helps the uterus to contract, early cord clamping and controlled cord traction to deliver the placenta. Different drugs have been tried and generally either intramuscular oxytocin or intramuscular syntometrine is given. Carbetocin is an oxytocin agonist. Oxytocin agonists are a group of drugs that mimic the oxytocin action, oxytocin being the natural hormone that helps to reduce blood loss at birth.

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Carbetocin versus oxytocin in caesarean section with high risk of post-partum haemorrhage

Taiwan J Obstet Gynecol. Carbetocin versus oxytocin for the prevention of postpartum hemorrhage: A meta-analysis of randomized controlled trials in cesarean deliveries. Electronic address: vhaxyn gmail. OBJECTIVE: Postpartum hemorrhage remains the leading cause of maternal mortality in developing countries and a significant proportion of these cases are attributable to uterine atony.

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