Please select the eligibility criteria that correspond to the clinical trial below.
Title: Carbetocin at Elective Cesarean Delivery: A Dose Finding Study (Part 2)
Brief Summary: Post-partum hemorrhage (PPH) is a major cause of maternal death worldwide. Oxytocin is the most common uterotonic drug used to prevent and treat PPH in North America, however, there are some limitations to its use. Oxytocin has a very short duration of action, which requires a continuous infusion to achieve sustained uterotonic activity. The Society of Obstetricians and Gynecologists of Canada (SOGC) has recently recommended a single 100mcg dose of carbetocin at elective Cesarean delivery to promote uterine contraction and prevent post partum hemorrhage (PPH), in lieu of the more traditional oxytocin regimens. Carbetocin lasts 4 to 7 times longer than oxytocin, with a similar side effect profile and apparent greater efficacy rate. However, a dose response to determine the minimum effective dose of carbetocin has not yet been published. The investigators hypothesize that the minimum effective dose (ED90) is above 20mcgs and below 80mcgs in women undergoing elective Cesarean delivery.


Options:
A: Inclusion Criteria:

* Vaginal delivery
* Postpartum hemorrhage due to suspected uterine atony
* Depending on study group: administration of prophylactic uterotonics in third stage of labor

Exclusion Criteria:

* Known allergy to misoprostol or other prostaglandin
* C-section for current delivery
B: Inclusion Criteria:

* All patients planned for elective cesarean delivery under spinal anesthesia.
* All patients who give written informed consent to participate in this study.

Exclusion Criteria:

* All patients who refuse to give written informed consent.
* All patients who claim allergy or hypersensitivity to carbetocin or oxytocin.
* All patients with conditions that predispose to uterine atony and postpartum hemorrhage such as placenta previa, multiple gestation, preeclampsia, eclampsia, macrosomia, polyhydramnios, uterine fibroids, previous history of uterine atony and postpartum bleeding, or bleeding diathesis.
* All patients with hepatic, renal, and vascular disease,
* All patients requiring general anesthesia prior to the administration of the study drug.
C: Inclusion Criteria:

* Healthy pregnant women undergoing elective caesarean section with regional anesthesia

Exclusion Criteria:

---Women with

* placenta praevia
* placental abruption
* multiple gestation
* pregnancy related complications and disorders (i.e. preeclampsia, gestational diabetes)
* pre-existing diseases (e.g. insulin-dependent diabetes, cardiovascular or renal diseases, thyroid disease
* taking medication with known impact on the cardiovascular system
* undergoing caesarean section with general anesthesia
* secondary caesarean section
D: Inclusion Criteria:

* gestational age between 37 and 42 weeks
* singleton pregnancy
* live fetus
* cephalic presentation
* neonatal birth weight of 2500-4500 g
* parity between one and five
* maternal age \< 35 years
* vaginal birth

Exclusion Criteria:

* blood pressure ≥ 140/90mmHg
* placenta previa
* placental abruption
* a history of any bleeding during pregnancy
* a history of curettage
* cesarean section or any uterine scar
* a history of postpartum hemorrhage
* polyhydramnios
* signs or symptoms of maternal infection
* known uterine anomalies
* history of any drug use during labor
* abnormal placentation)
* coagulation defects
* instrumental deliveries
* hemoglobin concentration \< 8 g/dL
* history of anticoagulant drugs
* beta-mimetic medications during pregnancy
* prolongation of the first stage of labor \> 15 hours.

Answer: B