Comparative Study between Carbetocin versus Oxytocin in Prevention of Post-Partum Haemorrhage Following Caesarean Section in High-Risk Pregnancies
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- Category: Vol. 85, June 2017
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Comparative Study between Carbetocin versus Oxytocin in Prevention of Post-Partum Haemorrhage Following Caesarean Section in High-Risk Pregnancies, FARID I. HASSAN, ABDALLAH K. AHMAD, MANAR M. KHALED and YAHYA M. DIWER
Abstract
Aim of Work: To compare the effectiveness of carbetocin and oxytocin when they are administered at caesarean section for the routine prevention of postpartum hemorrhage in patients with high risk factors of PPH.
Background: One of the Millennium Development Goals set by the United Nations in 2000 is to reduce maternal mortality by three-quarters by 2015. If this is to be achieved, maternal deaths related to Postpartum Hemorrhage (PPH) must be significantly reduced [1].
Study Design: This is a comparative prospective, case-controlled, single centre study (1:1 ratio) conducted from July 2015 and October 2016.
Patients and Methods: Two hundred pregnant women between 34 and 42 weeks of gestation with a viable fetus or fetuses and at least one or more risk factor for PPH undergoing elective or emergency caesarean section under regional ana-esthesia. Women were randomised to receive either carbetocin (100 cases)-Group A or oxytocin (100 cases) Group B. (Group A) received a bolus of 100μg IV. (Group B) received 20IU of oxytocin in 500ml of 0.9% NaCl solution as infusion (150 mL/hour) by the anaesthetist after the birth of the baby.
Results: The two groups were comparable in the indication of CS (p=0.954). The most frequent indication was previous CS in carbetocin group and obstructed labor in the oxytocin group. Failed induction of labor was a common indication in the two groups. The amount of blood loss after delivery of the baby ranged between 300 and 1700ml. Blood loss in carbetocin group was significantly lower than that in oxytocin group. The frequency of blood loss ³1000ml was higher in oxytocin group. There was significant difference between the two groups with p-value 0.005. Additional uterotonic drugs were administered to 43 women of oxytocin group compared to 18 women of carbetocin group (p<0.001).
Conclusions: The current study provides sufficient evi-dence that carbetocin is more effective than oxytocin in reducing the need for additional uterotonic agents in patients at high risk for PPH undergoing CS (43% vs. 18% and p<0.001). A single injection of carbetocin appears to be more effective than a continuous infusion of oxytocin to maintain adequate uterine tone with statistically significant better uterine contractility in carbetocin group.