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Pan Y, Wang Y, Miao J, Ji X, Wu C, Wang Y, Ding H. Risk Factors for Postpartum Hemorrhage in Severe Pre-Eclampsia: A Retrospective Single-Centre Study of 1953 Cases. Med Sci Monit 2024; 30:e943772. [PMID: 38845159 PMCID: PMC11166088 DOI: 10.12659/msm.943772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/11/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Severe pre-eclampsia (sPE) and postpartum hemorrhage (PPH) in pregnancy have serious impact on maternal and fetal health and life. Co-occurrence of sPE and PPH often leads to poor pregnancy outcomes. We explored risk factors associated with PPH in women with sPE. MATERIAL AND METHODS This retrospective study included 1953 women with sPE who delivered at the Women's Hospital of Nanjing Medical University between April 2015 and April 2023. Risk factors for developing PPH in sPE were analyzed, and subgroups were analyzed by delivery mode (cesarean and vaginal). RESULTS A total of 197 women with PPH and 1756 women without PPH were included. Binary logistic regression results showed twin pregnancy (P<0.001), placenta accreta spectrum disorders (P=0.045), and placenta previa (P<0.001) were independent risk factors for PPH in women with sPE. Subgroup analysis showed risk factors for PPH in cesarean delivery group were the same as in the total population, but vaginal delivery did not reduce risk of PPH. Spinal anesthesia reduced risk of PPH relative to general anesthesia (P=0.034). Vaginal delivery group had no independent risk factors for PPH; however, magnesium sulfate (P=0.041) reduced PPH incidence. CONCLUSIONS Women with twin pregnancy, placenta accreta spectrum disorders, placenta previa, and assisted reproduction with sPE should be alerted to the risk of PPH, and spinal anesthesia should be preferred in cesarean delivery. Magnesium sulfate should be used aggressively in women with sPE; however, the relationship between magnesium sulfate and PPH risk needs further investigation.
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Rabow S, Jonsson H, Bro E, Olofsson P. Cardiovascular effects of oxytocin and carbetocin at cesarean section. A prospective double-blind randomized study using noninvasive pulse wave analysis. J Matern Fetal Neonatal Med 2023; 36:2208252. [PMID: 37150593 DOI: 10.1080/14767058.2023.2208252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND Oxytocin is routinely administered after delivery for prophylaxis and treatment of postpartum hemorrhage, but it is associated with considerable cardiovascular side-effects. Carbetocin, a synthetic oxytocin analogue, has a myometrial contraction effect of 60 min when given IV, compared with 16 min for oxytocin. OBJECTIVE To investigate whether there are differences in cardiovascular effects between oxytocin and carbetocin up to 1 h after treatment. METHODS Sixty-one healthy pregnant women undergoing elective cesarean section in spinal anesthesia were randomized to receive an IV bolus of either five units (8.3 µg) of oxytocin or 100 µg of carbetocin after delivery of the baby. Heart rate (HR), mean arterial blood pressure, ECG ST index, oxygen saturation (SaO2), and photoplethysmographic digital pulse wave analysis variables were recorded before and at 1, 5, 20, and 60 min after drug administration. Vasopressor use, uterine tonus, total bleeding, and need for additional uterotonics were also assessed. Repeated measurement ANOVA was used for statistical analyses. RESULTS The drugs had equal vasodilatory and hypotensive effects. Oxytocin, but not carbetocin, caused a decrease in HR at 1 min and a sustained decrease in cardiac left ventricular ejection time. Aggregate vasopressor use was higher in the carbetocin group. Neither drug caused any change in ST index, SaO2, or subjective cardiac symptoms. Uterine tonus, need for additional uterotonics, or total bleeding did not differ significantly between the groups. CONCLUSION Single doses of oxytocin and carbetocin had similar dilatory effects on vascular tonus, where the difference in aggregate vasopressor use can be attributed to a more persistent hypotensive effect of carbetocin. A transient negative chronotropic and sustained negative inotropic effect occurred after oxytocin. Neither drug showed any alarmingly adverse effects. Differences in drug effects may be attributed to differences in oxytocin and vasopressin receptor signaling pathways.
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Affiliation(s)
- Sofus Rabow
- Department of Anesthesiology and Intensive Care, Institution of Clinical Sciences Lund, Lund University, and Skåne University Hospital, Lund, Sweden
| | - Hanna Jonsson
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences Malmö, Lund University, and Skåne University Hospital, Malmö, Sweden
| | - Emilie Bro
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences Malmö, Lund University, and Skåne University Hospital, Malmö, Sweden
| | - Per Olofsson
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences Malmö, Lund University, and Skåne University Hospital, Malmö, Sweden
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Yılmaz Ergani S, Dicle İ, Aksan A, İbanoğlu MC, Tokgöz Çakır B, Kınay T, Erkaya S, İskender CT, Çelen Ş, Çağlar AT, Engin-Üstün Y. Postoperative care in the caesarean intensive care unit: experience from a tertiary maternity hospital. J Turk Ger Gynecol Assoc 2023; 24:42-47. [PMID: 35266372 PMCID: PMC10019003 DOI: 10.4274/jtgga.galenos.2022.2021-9-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective The aim was to determine whether follow-up in the intensive care unit (ICU) for the postoperative first eight hours was beneficial for early intervention in postpartum hemorrhage. Material and Methods In our hospital, all patients are admitted to the ICU for the first eight hours after cesarean section. Patients with postpartum hemorrhage after cesarean delivery who received medical and/or surgical treatment between 2016 and 2020 were reviewed in the presented study retrospectively. Results All cases (n=36,396) who underwent cesarean delivery were reviewed. Three hundred and fifty-nine patients with postpartum hemorrhage were identified and included. In the study group the time between cesarean section and diagnosis of postpartum hemorrhage was 10.1±19.1 hours, and the time between cesarean section and re-laparotomy was 9.26±23.1 hours. A total of three maternal deaths occurred after cesarean section in our hospital. In the last five years, the mortality rate in patients delivering by cesarean section was 3.9 per 100,000. The incidence of postpartum hemorrhage in cesarean deliveries at our hospital was calculated to be 1.0%, and the rate of obstetric near-miss events was calculated to be 0.6 per 1000 live births. Conclusion Follow-up of patients in the ICU in the first eight postoperative hours after cesarean section may result in a lower number of re-laparotomies due to postpartum hemorrhage, a shortened interval between cesarean section and re-laparotomy, and a lower maternal mortality rate.
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Affiliation(s)
- Seval Yılmaz Ergani
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - İskender Dicle
- Clinic of Hematology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Alperen Aksan
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Müjde Can İbanoğlu
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Betül Tokgöz Çakır
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Tuğba Kınay
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Salim Erkaya
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Can Tekin İskender
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Şevki Çelen
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Ali Turhan Çağlar
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Yaprak Engin-Üstün
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
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Sadeghi Afkham M, Hashemnejad M, Esmaelzadeh Saeieh S, Ataei M, Valizadeh R. Prophylactic effect of rectal and sublingual misoprostol on postpartum hemorrhage in mothers with preeclampsia following cesarean section surgery; a double-blind randomized controlled trial. Ann Med Surg (Lond) 2022; 80:104175. [PMID: 36045818 PMCID: PMC9422181 DOI: 10.1016/j.amsu.2022.104175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/10/2022] [Accepted: 07/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background Postpartum hemorrhage is one of the three major causes of maternal morbidity and mortality, so delay in the diagnosis and proper management of postpartum hemorrhage is of great importance. The present study aimed to determine the prophylactic effect of misoprostol on postpartum hemorrhage in patients with preeclampsia. Methods This was a double-blind randomized controlled clinical trial performed on 128 pregnant women with preeclampsia undergoing cesarean section in Kamali hospital in Karaj. After cesarean delivery, immediately after clamping the umbilicus, the first group was administered 400 μg of rectal misoprostol and the second group was given 400 μg of sublingual misoprostol. The third group (control) was given 30 units of oxytocin during surgery and within 12 h after surgery, respectively. Hemoglobin and hematocrit were measured 24 h later. The estimated bleeding rate by the physician, the need for additional medication to control bleeding, and the amounts of hemoglobin and hematocrit in the first 24 h were compared in the three groups. Finally, the obtained information was entered into SPSS version 21 and analyzed using statistical tests. Results The mean hemoglobin and hematocrit levels 6 and 12 h after cesarean section were significantly lower in the oxytocin group than in the sublingual and rectal misoprostol groups (Hemoglobin level (mg/dl) for oxytocin group 10.39 ± 0.73 and 9.53 ± 1.09 vs. sublingual misoprostol 11.05 ± 0.71 and 10.39 ± 0.84 vs. rectal misoprostol 10.92 ± 0.85 and 10 ± 1.01; hematocrit level for Hemoglobin level (%) for oxytocin group 31.27 ± 2.29 and 28.64 ± 2.93 vs. sublingual misoprostol 33.09 ± 2.20 and 31.05 ± 2.37 vs. rectal misoprostol 32.54 ± 2.7 and 29.92 ± 2.86) (p < 0.005). The mean estimation of visual bleeding in the oxytocin group was higher than the other three groups, followed by the rectal and the sublingual groups, respectively. However, there was no significant difference between the three groups regarding visual bleeding. There was no significant difference in hemoglobin and hematocrit between the two groups of sublingual and rectal misoprostol before and 6 and 12 h after the surgery (P > 0.05). Conclusion It seems that sublingual or rectal misoprostol administration along with oxytocin is associated with a reduction in postpartum cesarean section bleeding compared to oxytocin administration alone. Hemoglobin level 6 and 12 h after cesarean section is significantly lower in the oxytocin group compared to the sublingual misoprostol group. Sublingual or rectal misoprostol administration along with oxytocin is associated with a reduction in postpartum cesarean section bleeding. Hemoglobin level 6 and 12 h after cesarean section is significantly lower in the oxytocin group compared to the rectal misoprostol group.
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Affiliation(s)
- Mansoureh Sadeghi Afkham
- Clinical Research Development Center of Kamali Hospital, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Maryam Hashemnejad
- Department of Obstetrics and Gynecology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Sara Esmaelzadeh Saeieh
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mina Ataei
- Department of Obstetrics and Gynecology, Social Determinants of Health, Research Center School of Medical Sciences, Alborz University of Medical Sciences, Karaj, Iran
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
- Corresponding author. Department of Obstetrics and Gynecology, Social Determinants of Health, Research Center School of Medical Sciences, Alborz University of Medical Sciences, Karaj, Iran.
| | - Rohollah Valizadeh
- Department of Biostatistics and Epidemiology, School of Medicine, Urmia University of Medical Science, Urmia, Iran
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Anneveldt KJ, van ’t Oever HJ, Verpalen IM, Nijholt IM, Bartels W, Dijkstra JR, van den Hoed RD, van ’t Veer - ten Kate M, de Boer E, Veersema S, Huirne JA, Schutte JM, Boomsma MF. Increased MR-guided high intensity focused ultrasound (MR-HIFU) sonication efficiency of uterine fibroids after carbetocin administration. Eur J Radiol Open 2022; 9:100413. [PMID: 35340827 PMCID: PMC8942847 DOI: 10.1016/j.ejro.2022.100413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/01/2022] Open
Abstract
Purpose We investigated whether administration of the long-acting uterus stimulant carbetocin increased intra-subject sonication efficiency during Magnetic Resonance image guided High Intensity Focused Ultrasound (MR-HIFU) treatment of uterine fibroids. Method In this prospective cohort study, thirty women with symptomatic uterine fibroids undergoing MR-HIFU treatment were included between January 2018 and January 2019. Treatment started with three sonications on one side of the uterine fibroid. Subsequently, one ampoule of 1 mL carbetocin (100 µg/mL) was administered intravenously and treatment continued with three sonications on the other side of the uterine fibroid. We compared the intra-subject sonication efficiency, in terms of Energy Efficiency Factor (EEF), thermal dose volume and sonication time to ablate one cm3 of fibroid tissue, before and after carbetocin administration. Adverse events that occurred within 30 min after carbetocin administration were recorded. Results Sonication efficiency improved after carbetocin administration as indicated by a significant decrease in EEF and sonication time (p = 0.006 and p = 0.001 respectively), and a significant increase in thermal dose volume reached (p = <0.001). Five women (16.7%) experienced temporary tachycardia, one women in combination with headache, within 30 min after carbetocin administration. Conclusion Administration of the long-acting uterus stimulant carbetocin improved the MR-HIFU treatment intra-subject sonication efficiency in women with symptomatic uterine fibroids.
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Affiliation(s)
- Kimberley J. Anneveldt
- Department of Radiology, Isala hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
- Department of Gynecology, Isala hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Heleen J. van ’t Oever
- Department of Emergency Healthcare, Isala hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Inez M. Verpalen
- Department of Radiology, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Ingrid M. Nijholt
- Department of Radiology, Isala hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Wilbert Bartels
- Image Sciences Institute, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Jeroen R. Dijkstra
- Department of Gynecology, Isala hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Rolf D. van den Hoed
- Department of Radiology, Isala hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | | | - Erwin de Boer
- Department of Radiology, Isala hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Sebastiaan Veersema
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Judith A.F. Huirne
- Department of Obstetrics and Gynecology and Amsterdam research institute Reproduction and Development, Amsterdam University Medical Centre, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Joke M. Schutte
- Department of Gynecology, Isala hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Martijn F. Boomsma
- Department of Radiology, Isala hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
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Ben Tareef A, Downey K, Ma B, Whittle WL, Carvalho JCA. Carbetocin versus oxytocin following vaginal and Cesarean delivery: a before-after study. Can J Anaesth 2021; 69:97-105. [PMID: 34713434 DOI: 10.1007/s12630-021-02127-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE A nationwide shortage of oxytocin in Canada resulted in a temporary switch from oxytocin to carbetocin for all postpartum women at our institution. This change offered a unique opportunity to conduct a pragmatic comparative assessment of the efficacy of carbetocin and oxytocin. METHODS In a retrospective before-after study, we reviewed the medical records from 641 women in the carbetocin group and 752 women in the oxytocin group . The standard carbetocin dosing was 100 µg iv following vaginal and intrapartum Cesarean delivery, while for elective Cesarean delivery it was 50 µg, with an additional 50 µg if required. The standard oxytocin dosing was 5 IU iv followed by 2.4 IU·hr-1 for four to six hours after vaginal delivery, while for Cesarean delivery it was 1-3 IU iv, three minutes apart, up to 10 IU if required, followed by the same maintenance. In both modalities of delivery, if uterine tone was suboptimal, the maintenance dose of oxytocin could be increased to 4.8 IU·hr-1. In both groups, additional uterotonics were used as required. The primary outcome was the need for additional uterotonics. Secondary outcomes included estimated and calculated blood loss, the occurrence of postpartum hemorrhage, and the need for blood transfusion. RESULTS The incidence of additional uterotonic use was not different between the carbetocin and oxytocin groups (12.0% vs 8.8%; P = 0.05; odds ratio, 1.39; 95% confidence interval, 0.97 to 2.00). The incidence of postpartum hemorrhage was higher in the carbetocin group than in the oxytocin group (10.3% vs 6.6%; P = 0.01). Blood transfusion was more common in the carbetocin group (1.4% vs 0.3%; P = 0.02). CONCLUSION There was no difference in the use of additional uterotonics when carbetocin or oxytocin were used in a cohort of women undergoing vaginal deliveries and both elective and emergency Cesarean deliveries.
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Affiliation(s)
- Ahmad Ben Tareef
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Kristi Downey
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Bernard Ma
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Wendy L Whittle
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Jose C A Carvalho
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada. .,Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
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Phung LC, Farrington EK, Connolly M, Wilson AN, Carvalho B, Homer CSE, Vogel JP. Intravenous oxytocin dosing regimens for postpartum hemorrhage prevention following cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol 2021; 225:250.e1-250.e38. [PMID: 33957113 DOI: 10.1016/j.ajog.2021.04.258] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/14/2021] [Accepted: 04/30/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To compare the available evidence on intravenous oxytocin dosing regimens for the prevention of postpartum hemorrhage following cesarean delivery. DATA SOURCES We searched Ovid MEDLINE, Embase, Global Index Medicus, Cumulative Index of Nursing and Allied Health Literature, Cochrane Controlled Register of Trials, ClinicalTrials.gov, and the International Clinical Trials Registry Platform for eligible studies published until February 2020. STUDY ELIGIBILITY CRITERIA We included any randomized or nonrandomized study published in peer-reviewed journals that compared at least 2 different dosing regimens of intravenous oxytocin for postpartum hemorrhage prevention in women undergoing cesarean delivery. METHODS Two authors independently assessed the eligibility of studies, extracted the data, and assessed the risk of bias. The primary outcome was incidence of postpartum hemorrhage ≥1000 mL. Other review outcomes included use of additional uterotonics, blood loss, and adverse maternal events. Data were analyzed according to the type of intravenous administration (bolus only, infusion only, or bolus plus infusion) and total oxytocin dose. A meta-analysis was performed on randomized trials and the results were reported as risk ratios or mean differences with 95% confidence intervals. The Grading of Recommendations, Assessment, Development, and Evaluations scale was used to rate the certainty of evidence. Findings from dose-finding trials and nonrandomized studies were reported narratively. RESULTS A total of 35 studies (7333 women) met our inclusion criteria and included 30 randomized trials and 5 nonrandomized studies. There were limited data available from the trials for most outcomes, and the results were not conclusive. Compared with bolus plus infusion regimens, bolus only regimens probably result in slightly higher mean blood loss (mean difference, 52 mL; 95% confidence interval, 0.4-104 mL; moderate certainty). Among the bolus plus infusion regimens, initial bolus doses <5 IU may reduce nausea (risk ratio, 0.26; 95% confidence interval, 0.11-0.63; low certainty) when compared with doses of 5-9 IU. Total oxytocin doses of 5-9 IU vs total doses of 10-19 IU may increase the use of additional uterotonics (risk ratio, 13.00; 95% confidence interval, 1.75-96.37; low certainty). Effects on other outcomes were generally inconclusive. CONCLUSION There are limited data available for comparisons of IV oxytocin regimens for postpartum hemorrhage prevention following cesarean delivery. Bolus plus infusion regimens may lead to minor reductions in mean blood loss and initial bolus doses of <5 IU may minimize nausea. Bolus only regimens of 10 IU vs bolus only regimens of 5 IU may decrease the need for additional uterotonics, however, further comparative trials are required to understand the effects on other key outcomes, particularly hypotension.
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Affiliation(s)
- Laura C Phung
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
| | - Elise K Farrington
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Mairead Connolly
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Alyce N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; School of Population and Global Health, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; School of Population and Global Health, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Australia
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Somjit M, Surojananon J, Kongwattanakul K, Kasemsiri C, Sirisom M, Prawannoa K, Thepsuthammarat K, Komwilaisak R. Comparison of Low Dose versus High Dose of Oxytocin for Initiating Uterine Contraction During Cesarean Delivery: A Randomized, Controlled, Non-Inferiority Trial. Int J Womens Health 2020; 12:667-673. [PMID: 32904472 PMCID: PMC7455765 DOI: 10.2147/ijwh.s260073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/09/2020] [Indexed: 12/28/2022] Open
Abstract
Background Oxytocin is used for initiating uterine contraction and preventing postpartum hemorrhage during caesarean delivery. Using a lower dosage of oxytocin may lower the risk of adverse effects while still being effective in stimulating initial uterine contraction. We aimed to compare the effectiveness and side effects of the standard 10 IU bolus of oxytocin with those of a 5 IU bolus during caesarean delivery. Patients and Methods We enrolled women in a randomized, double-blind, study comparing intravenous injections of high-dose (10 IU) and low-dose (5 IU) oxytocin administered after clamping of the umbilical cord. The primary outcome was adequate uterine contraction within the first 3 mins after administration. Secondary outcomes included uterine tone, use of additional uterotonic agents, additional obstetrics procedures, and oxytocin-related adverse events. Results A total of 155 women underwent randomization, with 78 in the low-dose group and 77 in the high-dose group. The proportion of women with adequate uterine contraction during the first 3 mins was 84.6% in the low-dose group and 77.9% in the high-dose group (relative risk, 1.09; 95% CI, 0.93 to 1.26). Methylergonovine maleate was used in 14.1% of cases in the low-dose group and 36.4% in the high-dose group (relative risk, 0.40; 95% CI, 0.22 to 0.73). The necessity for additional obstetric procedures, estimated blood loss >500 mL, neonatal outcomes, and oxytocin-related adverse effects did not differ significantly between the two groups. Conclusion The 5 IU bolus of oxytocin was noninferior to the standard 10 IU bolus of oxytocin for initiating adequate uterine contraction, required fewer additional uterotonic agents, and led to fewer oxytocin-related adverse events.
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Affiliation(s)
- Monsicha Somjit
- Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Jaruta Surojananon
- Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kiattisak Kongwattanakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Cattleya Kasemsiri
- Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Monthira Sirisom
- Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Khuantipa Prawannoa
- Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Ratana Komwilaisak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Ibrahim ZM, Sayed Ahmed WA, Abd El-Hamid EM, Taha OT, Elbahie AM. Carbetocin versus oxytocin for prevention of postpartum hemorrhage in hypertensive women undergoing elective cesarean section. Hypertens Pregnancy 2020; 39:319-325. [PMID: 32421401 DOI: 10.1080/10641955.2020.1768268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Assess the efficacy and safety of carbetocin, versus oxytocin in the prevention of postpartum hemorrhage in hypertensive women. STUDY DESIGN A randomized clinical trial. SETTING Obstetrics and Gynecology Department of Suez Canal University Hospital. PATIENTS One hundred and sixty hypertensive pregnant women who underwent CS. INTERVENTIONS Patients were randomized to receive either 10 IU oxytocin or 100 μg carbetocin. Primary outcomes included estimated blood loss, blood transfusion, hemoglobin (HB), and hematocrit changes pre- and post-delivery and the use of additional uterotonics. RESULTS The postoperative HB was not different from preoperative HB in the carbetocin group (11.8 ± 1.2 vs. 11.2 ± 1.2 g/dL) while it decreased significantly in the oxytocin group (12.1 ± 3.8 vs. 10.4 ± 1.1 g/dL, p < 0.001). Blood loss was significantly more among the oxytocin group (679.5 ± 200.25 vs. 424.75 ± 182.59 ml) in the carbetocin group (p < 0.001). Nausea, vomiting, and sweating were reported more significantly in oxytocin group patients. CONCLUSION Carbetocin was more effective than oxytocin in reducing intraoperative and postoperative blood loss.
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Affiliation(s)
- Zakia M Ibrahim
- Obstetrics and Gynecology Department, Faculty of Medicine, Suez Canal University , Ismailia, Egypt
| | - Waleed A Sayed Ahmed
- Obstetrics and Gynecology Department, Faculty of Medicine, Suez Canal University , Ismailia, Egypt
| | - Eman M Abd El-Hamid
- Obstetrics and Gynecology Department, Faculty of Medicine, Suez Canal University , Ismailia, Egypt
| | - Omima T Taha
- Obstetrics and Gynecology Department, Faculty of Medicine, Suez Canal University , Ismailia, Egypt
| | - Amira M Elbahie
- Obstetrics and Gynecology Department, Faculty of Medicine, Suez Canal University , Ismailia, Egypt
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10
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Dell-Kuster S, Hoesli I, Lapaire O, Seeberger E, Steiner LA, Bucher HC, Girard T. Efficacy and safety of carbetocin given as an intravenous bolus compared with short infusion for Caesarean section - double-blind, double-dummy, randomized controlled non-inferiority trial. Br J Anaesth 2018; 118:772-780. [PMID: 28498927 DOI: 10.1093/bja/aex034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2017] [Indexed: 11/13/2022] Open
Abstract
Background Carbetocin is a synthetic oxytocin-analogue, which should be administered as bolus according to manufacturer's recommendations. A higher speed of oxytocin administration leads to increased cardiovascular side-effects. It is unclear whether carbetocin administration as short infusion has the same efficacy on uterine tone compared with bolus administration and whether haemodynamic parameters differ. Methods In this randomized, double-blind, non-inferiority trial, women undergoing planned or unplanned Caesarean section (CS) under regional anaesthesia received a bolus and a short infusion, only one of which contained carbetocin 100 mcg (double dummy). Obstetricians quantified uterine tone two, three, five and 10 min after cord-clamping by manual palpation using a linear analogue scale from 0 to 100. We evaluated whether the lower limit of the 95% CI of the difference in maximum uterine tone within the first five min after cord-clamping did not include the pre-specified non-inferiority limit of -10. Results Between December 2014 and November 2015, 69 patients were randomized to receive carbetocin as bolus and 71 to receive it as short infusion. Maximal uterine tone was 89 in the bolus and 88 in the short infusion group (mean difference -1.3, 95% CI -5.7 to 3.1). Bp, calculated blood loss, use of additional uterotonics, and side-effects were comparable. Conclusions Administration of carbetocin as short infusion does not compromise uterine tone and has similar cardiovascular side-effects as a slow i.v. bolus. In accordance with current recommendations for oxytocin, carbetocin can safely be administered as short -infusion during planned or unplanned CS. Clinical trial registration ClinicalTrials.gov NCT02221531 and www.kofam.ch SNCTP000001197.
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Affiliation(s)
- S Dell-Kuster
- Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, Basel, Switzerland.,Basel Institute for Clinical Epidemiology and Biostatistics, Basel, Switzerland
| | - I Hoesli
- Basel Institute of Clinical Epidemiology and Biostatistics, University Basel, Basel, Switzerland.,Department of Clinical Research, University Basel, Basel, Switzerland
| | - O Lapaire
- Basel Institute of Clinical Epidemiology and Biostatistics, University Basel, Basel, Switzerland
| | - E Seeberger
- Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, Basel, Switzerland
| | - L A Steiner
- Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, Basel, Switzerland.,Department of Clinical Research, University Basel, Basel, Switzerland
| | - H C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, Basel, Switzerland.,Department of Clinical Research, University Basel, Basel, Switzerland
| | - T Girard
- Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, Basel, Switzerland
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11
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Adverse Effects of Carbetocin versus Oxytocin in the Prevention of Postpartum Haemorrhage after Caesarean Section: A Randomized Controlled Trial. J Pregnancy 2018; 2018:1374150. [PMID: 29484209 PMCID: PMC5816867 DOI: 10.1155/2018/1374150] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/15/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose To compare the incidence of nausea, vomiting, and arterial hypotension between carbetocin and oxytocin to prevent haemorrhage after caesarean section (CS). Methods A randomized controlled trial in term pregnant women undergoing planned CS. Groups were randomized to carbetocin or oxytocin. Blood pressure (BP), heart rate, presence of nausea/vomitus, and need for vasopressors were evaluated throughout surgery. Preoperative and postoperative haemoglobin and haematocrit levels were compared. Results Fifty-eight women were randomized (carbetocin n = 32; oxytocin n = 26). Both medications had hypotensive effect, difference in BP for carbetocin versus oxytocin: systolic (14.4 ± 2.4 mmHg versus 8.5 ± 1.8 mmHg); diastolic (7.8 ± 1.6 mmHg versus 8.9 ± 3.0 mmHg) without significant difference between the drugs (p = 0.1 and p = 0.7). Both groups had similar needs for vasopressors. The presence of nausea was not rare, but the difference was not statistically significant (p = 0.4). Average blood loss was slightly lower in the carbetocin group but not statistically significant (p = 0.8). Conclusion In planned CS, a possible clinical significant lower incidence of nausea after carbetocin was noted but this was not statistically significant. There were no differences regarding BP, heart rate, the need for vasopressor, and blood loss. The study was registered in the International Journal of Clinical Trials (ISRCTN 95504420, 2/2017).
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12
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Caceda SI, Ramos RR, Saborido CM. Pharmacoeconomic study comparing carbetocin with oxytocin for the prevention of hemorrhage following cesarean delivery in Lima, Peru. J Comp Eff Res 2017; 7:49-55. [PMID: 29264934 DOI: 10.2217/cer-2017-0012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Postpartum hemorrhage is one of the main causes of maternal death. Oxytocin has traditionally been used to prevent postpartum hemorrhage. AIM To compare oxytocin with carbetocin, a long-acting analog of oxytocin, for prevention of uterine hemorrhage after cesarean delivery. MATERIALS & METHODS Clinical data were retrieved from the 2012 Cochrane meta-analysis "Carbetocin for preventing postpartum hemorrhage". A decision tree was constructed. The direct costs were those of medications from the Peruvian official price list (DIGEMID). Costs associated with additional oxytocic drugs, blood transfusions, postpartum hemorrhage kits and hysterectomy were obtained from Hospital Nacional Edgardo Rebagliati Martins. The perspective of the study was that of the payer. The time horizon for calculating quality-adjusted life years (QALYs) was 1 year (2015). RESULTS Patients who received carbetocin required fewer additional uterotonic agents, had fewer hemorrhages and received fewer blood transfusions. Therefore, the costs associated with these interventions were lower. The incremental cost-effectiveness ratio was S/. 49,918 per QALY gained, which is lower than the threshold we estimated for Peru. CONCLUSION Carbetocin is more cost-effective than oxytocin for prevention of uterine hemorrhage after cesarean delivery.
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Affiliation(s)
- Sonia Indacochea Caceda
- Médico Internista, Magister en Farmacoeconomía y Economía de la Salud, Médico Asistente del Hospital Nacional Edgardo Rebagliati Martins, Presidenta de ISPOR PERU, Lima, Perú
| | - Richard Rubio Ramos
- Médico Internista, Maestría en Epidemiología Clínica, Médico Asistente del Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Carlos Martín Saborido
- Director de la Unidad de Evaluación de Tecnologías Sanitarias, Universidad Francisco de Vitoria, Madrid, Spain
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13
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van der Nelson HA, Draycott T, Siassakos D, Yau CW, Hatswell AJ. Carbetocin versus oxytocin for prevention of post-partum haemorrhage at caesarean section in the United Kingdom: An economic impact analysis. Eur J Obstet Gynecol Reprod Biol 2017; 210:286-291. [DOI: 10.1016/j.ejogrb.2017.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 12/16/2016] [Accepted: 01/02/2017] [Indexed: 11/25/2022]
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14
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Meshykhi L, Nel M, Lucas D. The role of carbetocin in the prevention and management of postpartum haemorrhage. Int J Obstet Anesth 2016; 28:61-69. [DOI: 10.1016/j.ijoa.2016.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/03/2016] [Indexed: 01/16/2023]
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15
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Nucci B, Aya A, Aubry E, Ripart J. Carbetocin for prevention of postcesarean hemorrhage in women with severe preeclampsia: a before-after cohort comparison with oxytocin. J Clin Anesth 2016; 35:321-325. [PMID: 27871550 DOI: 10.1016/j.jclinane.2016.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 08/09/2016] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE The aim of the study was to compare the incidence of the use of additional uterotonics before and after the change of carbetocin to oxytocin for the prevention of postpartum hemorrhage after cesarean delivery in women with severe preeclampsia. DESIGN This was an observational retrospective before-and-after study. SETTING Operating room, postoperative recovery area. PATIENTS Sixty women with severe preeclampsia undergoing cesarean delivery under spinal anesthesia; American Society of Anesthesiologists 3. INTERVENTIONS Observational study. MEASUREMENTS Blood pressure, heart rate, and biological data (hemoglobin, platelets, haptoglobin, prothrombin time index, activated partial thromboplastin time ratio, blood uric acid, aspartate aminotransferase, alanine aminotransferase, serum urea, serum creatinine, and albumin). MAIN RESULTS The incidence of additional uterotonic administration in the carbetocin and oxytocin groups was 15% and 10%, respectively (P=.70). CONCLUSIONS As carbetocin appears to be as effective and safe as oxytocin in preeclamptic women, its advantages make it a good uterotonic option in this particular setting.
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Affiliation(s)
- B Nucci
- Division of Anesthesiology, Pain, Emergency and Critical Care Medicine, Caremeau University Hospital, Nîmes, France.
| | - Agm Aya
- Division of Anesthesiology, Pain, Emergency and Critical Care Medicine, Caremeau University Hospital, Nîmes, France
| | - E Aubry
- Division of Anesthesiology, Pain, Emergency and Critical Care Medicine, Caremeau University Hospital, Nîmes, France
| | - J Ripart
- Division of Anesthesiology, Pain, Emergency and Critical Care Medicine, Caremeau University Hospital, Nîmes, France
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16
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In Vitro Comparative Effect of Carbetocin and Oxytocin in Pregnant Human Myometrium with and without Oxytocin Pretreatment. Anesthesiology 2016; 124:378-86. [DOI: 10.1097/aln.0000000000000940] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Background
The purpose of this study was to compare in vitro contractile effects of oxytocin and carbetocin on human term pregnant myometrium with and without oxytocin pretreatment.
Methods
This laboratory investigation was conducted on myometrial samples from women undergoing elective cesarean deliveries. The samples were dissected into four strips and suspended in individual organ bath chambers containing physiologic salt solution. After equilibration, they were pretreated with oxytocin 10−5 M (experimental group) or physiologic salt solution (control group) for 2 h and then subjected to dose–response testing with increasing concentrations of oxytocin or carbetocin (10−10 to 10−5 M). The amplitude, frequency, motility index (amplitude × frequency), and area under the curve of contractions were recorded and analyzed during the equilibration and dose–response periods. Comparisons were made between oxytocin-induced and carbetocin-induced contractions in control and oxytocin-pretreated groups. Motility index was the primary outcome measure.
Results
Sixty-three experiments were performed (carbetocin, n = 31; oxytocin, n = 32) on samples from 18 women. The motility index of contractions (√g.contractions/10 min) produced by oxytocin was significantly higher than carbetocin in both control (regression-estimated difference, 0.857; 95% CI, 0.290 to 1.425; P = 0.003) and oxytocin-pretreated (0.813; 0.328 to 1.299; P = 0.001) groups. The motility index was significantly lower in oxytocin-pretreated groups than their respective controls for both oxytocin (−1.040; −1.998 to −0.082; P = 0.03) and carbetocin (−0.996; −1.392 to −0.560; P < 0.001).
Conclusions
In vitro contractions produced by oxytocin are superior to carbetocin in human myometrium with or without oxytocin pretreatment. Oxytocin pretreatment results in attenuation of contractions induced by both oxytocin and carbetocin.
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17
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Pizzagalli F, Agasse J, Marpeau L. [Carbetocin versus Oxytocin during caesarean section for preventing postpartum haemorrhage]. ACTA ACUST UNITED AC 2015; 43:356-60. [PMID: 25892107 DOI: 10.1016/j.gyobfe.2015.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 03/04/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study was to compare the effectiveness of Carbetocin versus Oxyotcin during caesarean section for preventing postpartum haemorrhage. METHODS Prospective observational study (before/after design). Five hundred and forty patients who received an injection of Oxytocin were compared to 262 patients with single injection of 100 micrograms of Carbetocin. The primary outcome was to compare the differential hematocrit level between pre- and postoperative blood samples. The secondary outcome was to compare differential hemoglobin level and the use of complementary therapies for postpartum haemorrhage. RESULTS We did not find any difference between the Oxytocin and Carbetocin groups on differential hematocrit level. There was no difference between the groups regarding the use of additionnal therapies (Sulproston injections, blood transfusions and surgery methods). The rate of postpartum haemorrhage was similar in the two groups (18.7% vs 21.6%; P=0.33). We found a lower percentage of patients with differential of hemoglobin level between 2 g/dL and 4 g/dL in the Carbetocin group (6.5% vs 15.6%, P<0.001). The proportion of patients requiring intravenous iron administration was significantly lower in the Carbetocin group (6.8% vs 13.8%, P=0.0036) CONCLUSION: According to the primary outcome, there is no difference in effectiveness between carbetocin and oxytocin. Carbetocin seems to reduce the need for postoperative intravenous iron injection.
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Affiliation(s)
- F Pizzagalli
- Clinique gynécologique et obstétricale, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France.
| | - J Agasse
- Clinique gynécologique et obstétricale, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - L Marpeau
- Clinique gynécologique et obstétricale, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
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18
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Dupont C, Ducloy-Bouthors AS, Huissoud C. [Clinical and pharmacological procedures for the prevention of postpartum haemorrhage in the third stage of labor]. ACTA ACUST UNITED AC 2014; 43:966-97. [PMID: 25447388 DOI: 10.1016/j.jgyn.2014.09.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the clinical and pharmacological procedures for the prevention of Postpartum Haemorrhage (PPH). MATERIALS AND METHODS We searched the Medline and the Cochrane Library (1st December 2004 to 1st March 2014) and we checked the international guidelines. RESULTS Vaginal birth: only the use of uterotonics reduces the incidence of PPH. Oxytocin is the treatment of choice if it is readily available (grade A). Oxytocin can be used either after the shoulders expulsion or rapidly after the placental delivery (grade B). A dose of 5 or 10IU must be administrated IV over at least 1minute or directly by an intramuscular injection (professional agreement) except in women with documented cardiovascular disease in which the duration of the IV perfusion should be over at least 5minutes (professional agreement). Mechanical procedures have no significant impact on PPH. The decision to use a collector bag is left to the medical team (professional agreement). A systematic complementary oxytocin perfusion is not recommended (professional agreement). Caesarean delivery: There is no evidence to recommend a particular type of caesarean technique to prevent PPH (professional agreement) but a lower uterine section is recommended (grade B). All types of incision expansion may be used (professional agreement). A controlled cord traction is associated with lower blood losses than manual removal of the placenta (grade B). A dose of 5 or 10IU can be injected (IV) over 1minute, and over 5minutes in women with cardiovascular disease (professional agreement). Carbetocin reduces the incidence of PPH but there is presently no inferiority study comparing oxytocin and carbetocin so that oxytocin remains the gold standard therapy to prevent PPH in C-section (professional agreement).
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Affiliation(s)
- C Dupont
- Réseau périnatal Aurore, université Lyon-1, hôpital de la Croix-Rousse, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France; EA 4129, laboratoire « santé, individu, société », faculté de médecine Laennec, 7, rue Guillaume-Paradin, 69372 Lyon cedex 08, France.
| | - A-S Ducloy-Bouthors
- Pôle d'anesthésie-réanimation, maternité Jeanne de Flandre, CHRU de Lille, 59037 Lille cedex, France
| | - C Huissoud
- Réseau périnatal Aurore, université Lyon-1, hôpital de la Croix-Rousse, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France; Inserm U846, Stem Cell and Brain Research Institute, 18, avenue Doyen-Lépine, 69675 Bron cedex, France
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19
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Schwartz M, Vasudevan A. Current Concepts in the Treatment of Major Obstetric Hemorrhage. CURRENT ANESTHESIOLOGY REPORTS 2013. [DOI: 10.1007/s40140-013-0033-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Weale N, Laxton C. Prophylactic use of oxytocin at caesarean section: where are the guidelines? Anaesthesia 2013; 68:1006-9. [DOI: 10.1111/anae.12337] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N. Weale
- North Bristol NHS Trust; Southmead Hospital; Bristol; UK
| | - C. Laxton
- North Bristol NHS Trust; Southmead Hospital; Bristol; UK
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