Please select the eligibility criteria that correspond to the clinical trial below.
Title: Carbetocin at Cesarean Delivery for Labor Arrest: A Dose Finding Study
Brief Summary: In 2009, the Society of Obstetricians and Gynecologists Canada, which produces national clinical guidelines on important women's health issues, recommended that a bolus of carbetocin 100 mcg into your vein should be used at elective cesarean delivery instead of oxytocin infusion for the prevention of bleeding after you deliver your baby. Similar to oxytocin, carbetocin has side effects that are dose-related. Although 100 mcg has been the recommend dose, studies in nonlaboring women suggest that doses lower than 100 mcg may be used to achieve the same degree of uterine contractility with less side effects. So far, the ideal dose to be used in cesarean sections for labouring women who have failure to progress in labour (failure of your cervix to dilate adequately to 10cm or the baby's head not descending the birth canal) has not been determined. This study is designed to determine the minimum carbetocin dose required during cesarean delivery for 'failure to progress' to achieve the best effect.


Options:
A: Inclusion Criteria:

* Age≥ 18 years
* Planned vaginal delivery
* Term ≥ 35 weeks of gestation
* Singleton pregnancy
* Informed consent form signed

Exclusion Criteria:

* History of venous (deep vein thrombosis and/or pulmonary embolism) or arterial (angina pectoris, myocardial infarction, stroke) thrombosis.
* History of epilepsy or seizure
* Any known cardiovascular, renal, liver disorders
* Auto-immune disease
* Sickle cell disease
* Severe hemorrhagic disease
* Placenta previa
* Abnormally invasive placenta (placenta accreta/increta/percreta)
* Abruptio placentae
* Eclampsia; hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome
* Multiple pregnancy
* In utero foetal death
* Administration of Low-Molecular-Weight Heparin or antiplatelet agents seven days before delivery
* Poor understanding of the French language
B: Inclusion Criteria:

* Cesarean section secondary to failure to progress in labour
* First stage of labour
* Received oxytocin for at least 4 hours

Exclusion Criteria:

* Require General Anesthesia
* Cardiac Disease
* Hypertension
* Predisposition to uterine atony and postpartum hemorrhage
C: Inclusion Criteria:Term mothers \[38-41 WOA\] above 18 years of age admitted at Mbarara Hospital, Uganda in active labor; anticipating vaginal delivery -

Exclusion Criteria:

Complicated labor:

1. confirmed intra-uterine fetal death
2. self-reported maternal heart disease
3. current diagnosis of severe malaria or acute bacterial infection,
4. multiple pregnancy,
5. induced or augmented labor,
6. elective Caesarean section,
7. ante-partum hemorrhage,
8. reported hypersensitivity to prostaglandins
9. altered cognitive status (ACS) as assessed by the MRAs. -
D: Inclusion Criteria:

* All patients who have given written informed consent to participate in this study.
* All patients planned for uncomplicated low transverse cesarean delivery secondary to labor arrest, under epidural anesthesia.
* ≥37 week pregnancy
* Singleton pregnancy
* Patients who have received oxytocin for at least 4 hours for labor augmentation
* ASA 1 or 2

Exclusion Criteria:

* Refusal or inability to obtain informed consent.
* All patients who claim allergy or hypersensitivity to oxytocin and carbetocin.
* Previous history of uterine atony or PPH
* Risk factors for PPH such as pre-eclampsia, polyhydramnios, uterine fibroids, bleeding diathesis and chorioamnionitis etc.
* Abnormal placental implantation (known or suspected)
* \> 3 cesarean sections in the past
* Previous classic uterine incision
* Macrosomia - Estimated fetal weight \> 4500g
* Hemoglobin \< 100g/L
* Cesarean section under general anesthesia
* ASA 3 and 4 or patients with hepatic, renal, cardiac (eg. Coronary artery disease) and vascular disease
* Genital development problems (eg. Abnormal uterus, cervix, vagina, etc.)
* Uncontrolled hypotension or hypertension
* Uncontrolled diabetes
* Abnormal heart rhythms and bradycardia
* Drug abusers

Answer: D