Carbetocin in the Prevention of Primary Postpartum Haemorrhage
Condition: Post Partum Hemorrhage
MeSH terms: Postpartum Hemorrhage; Hemorrhage
Study type: Observational

Summary: 
      Postpartum haemorrhage (PPH) ranks as the first cause of maternal mortality in developing
      countries and it is the cause of 25% of maternal deaths worldwide.

      Carbetocin is a long-acting synthetic octapeptide analogue of oxytocin with agonist
      properties. Like oxytocin, carbetocin binds to oxytocin receptors present on the smooth
      musculature of the uterus, resulting in rhythmic contractions of the uterus, increased
      frequency of existing contractions and increased uterine tone.
    

Detailed description: 
      Postpartum hemorrhage is defined as a blood loss more than 500 ml, and serious PPH as a blood
      loss more than 1,000 ml.

      It is a common maternal morbidity in high-resource countries and is trending upward and
      prevention of postpartum haemorrhage is, therefore, of great importance for improved maternal
      health care.

      Although two-thirds of the PPH cases occur in women without predisposing factors, there are
      several risk factors for PPH. The most frequent cause of PPH is uterine atony, contributing
      up to 80 % of the PPH cases .

      Studies investigating effect of increased BMI on birth outcomes in a general obstetric
      population revealed an association between obesity and PPH. The overall increased risk of
      postpartum hemorrhage among obese women was 8-13%, depending on obesity class.

      The risk of postpartum haemorrhage is much higher for women undergoing Cesarean section,
      particularly in developing countries, where the majority of operations are carried out as an
      emergency procedure.

      Maternal obesity is associated with an elevated risk of intrapartum cesarean section, mainly
      due to reduced uterine contractility culminating in failure to progress in labor .

      Up to date, which uterotonic agent suitable for prophylactic use is being debated and
      literature lacks of clear endpoints on this item .

      The most routinely and widely used uterotonic agent for preventing postpartum haemorrhage is
      oxytocin, but it only has a half-life of 4-10 min. So, it must be administered as a
      continuous intravenous infusion to achieve sustained uterotonic activity, which is
      inconvenient and makes dosing errors a possibility.
    

Intervention name(s): Carbetocin
Intervention type(s): Drug
Intervention description(s): To assess the effectiveness of single IV bolus dose of carbetocin in the prevention of primary PPH in obese versus non obese women undergoing elective cesarean section.
Other intervention name(s): Oxytocin
Intervention MeSH terms: Oxytocin; Carbetocin
Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        To assess the effectiveness of single IV bolus dose of carbetocin in the prevention of
        primary PPH in obese versus non obese women undergoing elective cesarean section.
      
Keywords: Obesity; PPH; BMI; Carbetocin; Oxytocin; Uterotonic