A retrospective comparison of Carbetocin and Oxytocin use in high-risk of postpartum hemorrhage pregnancies undergoing cesarean section: The need for additional uterotonic drugs
Keywords:
postpartum hemorrhage, cesarean section, Carbetocin, OxytocinAbstract
Introduction: Postpartum hemorrhage (PPH) is a common complication and leading cause of maternal mortality worldwide. The primary cause is uterine atony, particularly in high-risk groups, including those undergoing cesarean section.
Objective: To evaluate and compare the requirements for additional uterotonic agents in high-risk of postpartum hemorrhage pregnancies undergoing cesarean section treated with either Carbetocin or Oxytocin.
Study Method: This retrospective study reviewed medical records of all patients who underwent cesarean section, both scheduled and emergency at San Sai Hospital, Chiang Mai, between July 1, 2023, and June 30, 2024. Eligible participants had a gestational age over 34 weeks and were identified as high risk for postpartum hemorrhage based on at least one risk factor. The primary outcome measured was the need for additional uterotonic agents during delivery in patients administered either Carbetocin or Oxytocin.
Results: A total of 129 eligible deliveries were included in the study, with 64 patients receiving Carbetocin and 65 receiving Oxytocin. There were no significant differences in personal and general characteristics between the two groups. In the Carbetocin group, additional uterotonic agents were used in 37.50% of cases, compared to 56.92% in the Oxytocin group with statistically significant difference at p = 0.027. The types of additional drugs used also differed significantly: in the Carbetocin group, 1.56% of patients received a combination of Methergine, Cytotec, and Nalador, while in the Oxytocin group, 13.85% received all three drugs (p = 0.009). There were no statistically significant differences between the two groups in terms of intraoperative blood loss, duration of surgery, type of anesthesia used, or drug-related side effects during or after surgery.
Conclusions: The findings indicate that Carbetocin use was associated with a lower need for additional uterotonic drugs compared to Oxytocin. However, when selecting a uterotonic agent for postpartum hemorrhage prevention, cost-effectiveness should also be considered in relation to patient outcome.
References
Committee on Practice Bullectins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol 2017;130(4):e168-86. doi: 10.1097/AOG.0000000000002351.
World Health Organization. Postpartum Haemorrhage Summit [Internet]. Switzerland: World Health Organization; c2022 [updated 2022 Sep 29; cited 2024 Jan 5]. Available from: https://www.who.int/publications/m/item/who-postpartum-haemorrhage-(pph)-summit
Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367(9516):1066-74. doi: 10.1016/S0140-6736(06)68397-9.
The Royal Thai College of Obstetricians and Gynaecologists. RTCOG Clinical Practice Guideline: Prevention and Management of Postpartum Hemorrhage [Internet]. Bangkok: RTCOG; c2022 [updated 2022 May 5; cited 2024 Nov 5]. Available from: https://www.rtcog.or.th/photo/cpg/OB-63-020.pdf [In Thai]
Hassan FI, Ahmad AK, Khaled MM, Diwer YM. Comparative study between carbetocin versus oxytocin in prevention of post-partum haemorrhage following caesarean section in high-risk pregnancies. Med J Cairo Univ. 2017;85(4):1469-75.
Attilakos G, Psaroudakis D, Ash J, Buchanan R, Winter C, Donald F, et al. Carbetocin versus oxytocin for the prevention of postpartum haemorrhage following caesarean section: the results of a double-blind randomised trial. BJOG 2010;117(8):929-36. doi: 10.1111/j.1471-0528.2010.02585.x.
Taheripanah R, Shoman A, Karimzadeh MA, Zamaniyan M, Malih N. Efficacy of oxytocin versus carbetocin in prevention of postpartum hemorrhage after cesarean section under general anesthesia: a prospective randomized clinical trial. J Matern Fetal Neonatal Med. 2018;31(21):2807-12. doi: 10.1080/14767058.2017.1355907.
Khalafalah MM. Oxytocin vs carbetocin in management of 3rd stage at risk of PPH. MOJ Women's Health. 2017;5(4):271-5. doi: 10.15406/mojwh.2017.05.00131.
Mohamed Maged A, Ragab AS, Elnassery N, Ai Mostafa W, Dahab S, Kotb A. Carbetocin versus syntometrine for prevention of postpartum hemorrhage after cesarean section. J Matern Neonatal Med. 2017;30(8):962-6. doi: 10.1080/14767058.2016.1192601.
Higgins L, Mechery J, Tomlinson AJ. Does carbetocin for prevention of postpartum haemorrhage at caesarean section provide clinical or financial benefit compared with oxytocin?. J Obstet Gynaecol. 2011;31(8):732-9. doi: 10.3109/01443615.2011.595982.
Korb D, Lopez R, Hörlin AL, Schmitz T, Borie C, Sibony O. Effectiveness of prophylactic carbetocin versus oxytocin following vaginal delivery for preventing severe postpartum hemorrhage. Int J Gynaecol Obstet. 2023;162(3):889-94. doi: 10.1002/ijgo.14743.
Meshykhi LS, Nel MR, Lucas DN. The role of carbetocin in the prevention and management of postpartum haemorrhage. Int J Obstet Anesth. 2016;28:61-9. doi: 10.1016/j.ijoa.2016.10.003.
Cordovani D, Carvalho JCA, Boucher M, Farine D. Carbetocin for the prevention of postpartum hemorrhage [Internet]. c2012 [updated 2021 Sep 27; cited 2024 Dec 12]. Available from: https://www.glowm.com/pdf/PPH_2nd_edn_Chap-44.pdf
Gallos ID, Papadopoulou A, Man R, Athanasopoulos N, Tobias A, Price MJ, et al. Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. Cochrane Database Syst Rev 2018;12(12):CD011689. doi: 10.1002/14651858.CD011689.pub3.
Mannaerts D, Van der Veeken L, Coppejans H, Jacquemyn Y. Adverse Effects of Carbetocin versus Oxytocin in the Prevention of Postpartum Haemorrhage after Caesarean Section: A Randomized Controlled Trial. J Pregnancy. 2018;2018:1374150. doi: 10.1155/2018/1374150.
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