Carbetocin Versus Oxytocin and Ergometrine for the Prevention of Postpartum Hemorrhage
Condition: Cesarean Section Complications
MeSH terms: Postpartum Hemorrhage; Hemorrhage
Study type: Interventional

Summary: 
      The cesarean section is a bloody operation, about 750 to 1000 ml are lost at most operations
      and over 1000 ml of blood have lost to bring them into the definition of a postpartum
      hemorrhage (PPH). In developing countries, PPH is the main cause of maternal deaths. Uterine
      atony is the most common cause of immediate heavy PPH.Multiple pregnancy ones of a common
      factor for uterine atony. The administration of oxytocic's after the delivery of the neonate
      reduces the likelihood of PPH and 5 IU oxytocin by slow intravenous injection is currently
      recommended for all cesarean sections. However, the use of additional oxytocic medication is
      common, to arrest bleeding, or prophylactically if there are risk factors for PPH .
      Carbetocin is a synthetic analog of human oxytocin with structural modifications that
      increase its half-life, thereby prolonging its pharmacological effects. Carbetocin has been
      approved in 23 countries for prevention of uterine atony and excessive bleeding following
      cesarean delivery in spinal or epidural anesthesia. Oxytocin is a peptide of nine amino acids
      (Nona peptide). The structure of oxytocin is very similar to that of arginine vasopressin,
      whose sequence differs from oxytocin by 2 amino acids. The best-known mechanism for oxytocin
      to exert its stimulatory effect on myometrial contractility is by increasing the
      intracellular concentration of calcium. Owing to its short plasma half-life (mean 3 min), a
      continuous intravenous infusion is required to maintain the uterus in a contracted state. The
      usual dose is 20 IU in 500 ml of crystalloid solution, with the dosage rate adjusted
      according to response. Ergometrine is a selective and moderately potent tryptaminergic
      receptor antagonist in various smooth muscles, being only a partially agonistic or
      antagonistic at tryptaminergic receptors in the central nervous system. In blood vessels, the
      alkaloid is only weakly antagonistic of dopaminergic receptors and partially agonistic of
      α-adrenergic receptors. oxytocin (19%). Blood loss>500 ml was only observed in women who
      received oxytocin. The aim of the investigator's study was to compare the effect of
      carbetocin vs. oxytocin and ergometrine for prevention of PPH during cesarean section in
      women with multiple pregnancies.
    

Detailed description: 
      Women included in the study were divided into 2 groups: Group (A): included patients who
      received carbetocin 100 µg diluted in 10 ml normal saline and administered slowly (over 30-60
      seconds) intravenously by anesthetist after the birth of the baby. Group (B): included
      patients who received a combination of intraoperative oxytocin 5 I.U which was diluted in 10
      ml normal saline and administered slowly over (30-60 seconds) intravenously by anesthetist
      and intramuscular ergometrine 0.2 mg. The slow administration has been shown to reduce the
      potentially harmful hemodynamic effects of oxytocin (and presumably carbetocin). Also,
      intramuscular injection of ergometrine did the same. All women were subjected to full history
      taking, general and obstetric examination and investigations in the form of preoperative
      routine labs and obstetric ultrasound, and postoperative serum hemoglobin %.
    

Intervention name(s): Carbetocin; oxytocin; ergometrine
Intervention type(s): Drug; Drug; Drug
Intervention description(s): Group (A): included 100 patients who received carbetocin 100 µg diluted in 10 ml normal saline and administered slowly (over 30-60 seconds) intravenously by anesthetist after the birth of the baby.; Group (B): included 100 patients who received a combination of intraoperative oxytocin 5 I.U which was diluted in 10 ml normal saline and administered slowly over (30-60 seconds) intravenously by anesthetist and; intramuscular ergometrine 0.2 mg.
Other intervention name(s): Pabal; Active Comparator; Active Comparator
Intervention MeSH terms: Oxytocin; Carbetocin; Ergonovine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The current study was a single-blinded randomized controlled trial conducted at a tertiary University Hospital Women included in the study were divided into 2 groups: Group (A): included 100 patients who received carbetocin 100 µg diluted in 10 ml normal saline and administered slowly (over 30-60 seconds) intravenously by anesthetist after birth of the baby. Group (B): included 100 patients who received a combination of intraoperative oxytocin 5 I.U which was diluted in 10 ml normal saline and administered slowly over (30-60 seconds) intravenously by anesthetist and intramuscular ergometrine 0.2 mg.
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: cesarean section; post-partum hemorrhage; multiple pregnancy