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CC BY-NC-ND 4.0 · AJP Rep 2020; 10(03): e241-e246
DOI: 10.1055/s-0040-1715163
Case Report

Carbetocin versus Oxytocin for the Prevention of Postpartum Hemorrhage in Cesarean Deliveries: A Retrospective Study of Two Consecutive Periods

Pierre Delorme
1   Department of Obstetrics and Gynecology, Trousseau Hospital, FHU Prema, Paris, France
2   Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
3   Paris Sorbonne University, Paris, France
,
Gilles Kayem
1   Department of Obstetrics and Gynecology, Trousseau Hospital, FHU Prema, Paris, France
2   Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
3   Paris Sorbonne University, Paris, France
4   Department of Obstetrics and Gynecology, Louis Mourier Hospital, FHU Prema, Paris, France
,
Hélène Legardeur
4   Department of Obstetrics and Gynecology, Louis Mourier Hospital, FHU Prema, Paris, France
6   Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland
,
Louise Anne Roux-Dessarps
4   Department of Obstetrics and Gynecology, Louis Mourier Hospital, FHU Prema, Paris, France
5   Department of Obstetrics and Gynecology, Centre Hospitalier Simone-Veil, Eaubonne, France
,
Guillaume Girard
1   Department of Obstetrics and Gynecology, Trousseau Hospital, FHU Prema, Paris, France
4   Department of Obstetrics and Gynecology, Louis Mourier Hospital, FHU Prema, Paris, France
,
Geraldine Meunier
4   Department of Obstetrics and Gynecology, Louis Mourier Hospital, FHU Prema, Paris, France
,
Hawa Keita
7   Department of Obstetric Anesthesia-Intensive Care, Louis Mourier Hospital, Paris, France
8   Department of Pediatric and Obstetric Anesthesia-Intensive Care, Necker Enfants Malades Hospital, APHP, Paris, France
9   Paris University, Paris, France
,
Laurent Mandelbrot
4   Department of Obstetrics and Gynecology, Louis Mourier Hospital, FHU Prema, Paris, France
9   Paris University, Paris, France
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Abstract

Objective The aim of the study is to investigate whether carbetocin prevents postpartum hemorrhage (PPH) more effectively than oxytocin

Methods This historical retrospective single-center cohort study compares women who underwent cesarean deliveries during two periods. During period A, oxytocin was used as a 10-unit bolus immediately after delivery, with 20 units thereafter infused for 24 hours. During period B, carbetocin in a single 100-µg injection replaced this protocol. The main outcome was PPH, defined as a decline in hemoglobin of more than 2 g/dL after the cesarean. The analysis was performed on the overall population and then stratified by the timing of the cesareans (before or during labor). A logistic regression analysis was performed.

Results This study included 1,796 women, 52% of whom had a cesarean before labor; 15% had a PPH. The crude PPH rate was lower in period B than in period A (13 vs. 17%, respectively, odds ratio 0.75, 95% confidence interval [CI]: 0.58–0.98). The difference was no longer significant in the multivariate analysis (adjusted odds ratio: 0.81, 95% CI 0.61–1.06). Results were similar when stratified by the timing of the cesareans (before or during labor).

Conclusion Carbetocin is not superior to oxytocin in preventing PPH. However, it does provide the advantage of requiring a single injection.

Keywords

oxytocin - carbetocin - postpartum hemorrhage - cesarean delivery


Publication History

Received: 24 January 2020

Accepted: 09 April 2020

Article published online:
27 August 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Say L, Chou D, Gemmill A. , et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2 (06) e323-e333
    CrossrefPubMedGoogle Scholar
  • 2 Saucedo M, Deneux-Tharaux C, Bouvier-Colle MH. ; French National Experts Committee on Maternal Mortality. Ten years of confidential inquiries into maternal deaths in France, 1998-2007. Obstet Gynecol 2013; 122 (04) 752-760
    CrossrefPubMedGoogle Scholar
  • 3 Kayem G, Deneux-Tharaux C. Invasive therapies for primary post-partum haemorrhage as missed opportunities for medical prevention. Curr Opin Obstet Gynecol 2017; 29 (02) 66-70
    CrossrefPubMedGoogle Scholar
  • 4 Dahlke JD, Mendez-Figueroa H, Maggio L. , et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol 2015; 213 (01) 76.e1-76.e10
    CrossrefPubMedGoogle Scholar
  • 5 Westhoff G, Cotter AM, Tolosa JE. Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage. Cochrane Database Syst Rev 2013; 10 (10) CD001808
    PubMedGoogle Scholar
  • 6 Sheldon WR, Blum J, Vogel JP, Souza JP, Gülmezoglu AM, Winikoff B. ; WHO Multicountry Survey on Maternal and Newborn Health Research Network. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014; 121 (Suppl. 01) 5-13
    CrossrefPubMedGoogle Scholar
  • 7 WHO WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. 2012 Geneva: WHO; 2012. . Accessed March 24, 2020 at: http://apps.who.int/iris/bitstream/10665/75411/1/9789241548502_eng.pdf
    Google Scholar
  • 8 Kayem G, Dupont C, Bouvier-Colle MH, Rudigoz RC, Deneux-Tharaux C. Invasive therapies for primary postpartum haemorrhage: a population-based study in France. BJOG 2016; 123 (04) 598-605
    CrossrefPubMedGoogle Scholar
  • 9 Gallos ID, Papadopoulou A, Man R. , et al. Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. Cochrane Database Syst Rev 2018; 12: CD011689
    CrossrefPubMedGoogle Scholar
  • 10 Gallos I, Williams H, Price M. , et al. Uterotonic drugs to prevent postpartum haemorrhage: a network meta-analysis. Health Technol Assess 2019; 23 (09) 1-356
    CrossrefPubMedGoogle Scholar
  • 11 Gallos ID, Coomarasamy A. Carbetocin: worth the extra expense?. Best Pract Res Clin Obstet Gynaecol 2019; 61: 55-65
    CrossrefPubMedGoogle Scholar
  • 12 Zhang WH, Deneux-Tharaux C, Brocklehurst P, Juszczak E, Joslin M, Alexander S. ; EUPHRATES Group. Effect of a collector bag for measurement of postpartum blood loss after vaginal delivery: cluster randomised trial in 13 European countries. BMJ 2010; 340: c293
    CrossrefPubMedGoogle Scholar
  • 13 Silberstein L, Anastasi J. Principles of red blood cell transfusion. In: Hoffman K. , ed. Hematology: Basic Principles and Practice. 6th ed. Orlando, FL: Churchill Livingstone; 2012
    Google Scholar
  • 14 Boucher M, Horbay GL, Griffin P. , et al. Double-blind, randomized comparison of the effect of carbetocin and oxytocin on intraoperative blood loss and uterine tone of patients undergoing cesarean section. J Perinatol 1998; 18 (03) 202-207
    PubMedGoogle Scholar
  • 15 Elgafor el Sharkwy IA. Carbetocin versus sublingual misoprostol plus oxytocin infusion for prevention of postpartum hemorrhage at cesarean section in patients with risk factors: a randomized, open trail study. Arch Gynecol Obstet 2013; 288 (06) 1231-1236
    CrossrefPubMedGoogle Scholar
  • 16 Moertl MG, Friedrich S, Kraschl J, Wadsack C, Lang U, Schlembach D. Haemodynamic effects of carbetocin and oxytocin given as intravenous bolus on women undergoing caesarean delivery: a randomised trial. BJOG 2011; 118 (11) 1349-1356
    CrossrefPubMedGoogle Scholar
  • 17 Reyes OA, Gonzalez GM. Carbetocin versus oxytocin for prevention of postpartum hemorrhage in patients with severe preeclampsia: a double-blind randomized controlled trial. J Obstet Gynaecol Can 2011; 33 (11) 1099-1104
    CrossrefPubMedGoogle Scholar
  • 18 Attilakos G, Psaroudakis D, Ash J. , et al. Carbetocin versus oxytocin for the prevention of postpartum haemorrhage following caesarean section: the results of a double-blind randomised trial. BJOG 2010; 117 (08) 929-936
    CrossrefPubMedGoogle Scholar
  • 19 Borruto F, Treisser A, Comparetto C. Utilization of carbetocin for prevention of postpartum hemorrhage after cesarean section: a randomized clinical trial. Arch Gynecol Obstet 2009; 280 (05) 707-712
    CrossrefPubMedGoogle Scholar
  • 20 Dansereau J, Joshi AK, Helewa ME. , et al. Double-blind comparison of carbetocin versus oxytocin in prevention of uterine atony after cesarean section. Am J Obstet Gynecol 1999; 180 (3 Pt 1): 670-676
    CrossrefPubMedGoogle Scholar
  • 21 Askar AA, Ismail MT, El-Ezz AA, Rabie NH. Carbetocin versus syntometrine in the management of third stage of labor following vaginal delivery. Arch Gynecol Obstet 2011; 284 (06) 1359-1365
    CrossrefPubMedGoogle Scholar
  • 22 Su LL, Rauff M, Chan YH. , et al. Carbetocin versus syntometrine for the third stage of labour following vaginal delivery--a double-blind randomised controlled trial. BJOG 2009; 116 (11) 1461-1466
    CrossrefPubMedGoogle Scholar
  • 23 Nirmala K, Zainuddin AA, Ghani NA, Zulkifli S, Jamil MA. Carbetocin versus syntometrine in prevention of post-partum hemorrhage following vaginal delivery. J Obstet Gynaecol Res 2009; 35 (01) 48-54
    CrossrefPubMedGoogle Scholar
  • 24 Leung SW, Ng PS, Wong WY, Cheung TH. A randomised trial of carbetocin versus syntometrine in the management of the third stage of labour. BJOG 2006; 113 (12) 1459-1464
    CrossrefPubMedGoogle Scholar
  • 25 Natrella M, Di Naro E, Loverro M. , et al. The more you lose the more you miss: accuracy of postpartum blood loss visual estimation. A systematic review of the literature. J Matern Fetal Neonatal Med 2018; 31 (01) 106-115
    CrossrefPubMedGoogle Scholar
  • 26 Gluck O, Mizrachi Y, Kovo M, Divon M, Bar J, Weiner E. Major underestimation and overestimation of visual blood loss during cesarean deliveries: can they be predicted?. Arch Gynecol Obstet 2017; 296 (05) 907-913
    CrossrefPubMedGoogle Scholar
  • 27 Audureau E, Deneux-Tharaux C, Lefèvre P. , et al. Practices for prevention, diagnosis and management of postpartum haemorrhage: impact of a regional multifaceted intervention. BJOG 2009; 116 (10) 1325-1333
    CrossrefPubMedGoogle Scholar
  • 28 Deneux-Tharaux C, Dupont C, Colin C. , et al. Multifaceted intervention to decrease the rate of severe postpartum haemorrhage: the PITHAGORE6 cluster-randomised controlled trial. BJOG 2010; 117 (10) 1278-1287
    CrossrefPubMedGoogle Scholar
  • 29 Belghiti J, Coulm B, Kayem G, Blondel B, Deneux-Tharaux C. Oxytocin administration during labor. Results from the 2010 French National Perinatal Survey [in French]. J Gynecol Obstet Biol Reprod (Paris) 2013; 42 (07) 662-670
    CrossrefPubMedGoogle Scholar
  • 30 Belghiti J, Kayem G, Dupont C, Rudigoz RC, Bouvier-Colle MH, Deneux-Tharaux C. Oxytocin during labour and risk of severe postpartum haemorrhage: a population-based, cohort-nested case-control study. BMJ Open 2011; 1 (02) e000514
    CrossrefPubMedGoogle Scholar
  • 31 El Behery MM, El Sayed GA, El Hameed AA, Soliman BS, Abdelsalam WA, Bahaa A. Carbetocin versus oxytocin for prevention of postpartum hemorrhage in obese nulliparous women undergoing emergency cesarean delivery. J Matern Fetal Neonatal Med 2016; 29 (08) 1257-1260
    CrossrefPubMedGoogle Scholar
  • 32 Deniau B, Bouhadjari N, Faitot V. , et al. Evaluation of a continuous improvement programme of enhanced recovery after caesarean delivery under neuraxial anaesthesia. Anaesth Crit Care Pain Med 2016; 35 (06) 395-399
    CrossrefPubMedGoogle Scholar
  • 33 Henríquez-Trujillo AR, Lucio-Romero RA, Bermúdez-Gallegos K. Analysis of the cost-effectiveness of carbetocin for the prevention of hemorrhage following cesarean delivery in Ecuador. J Comp Eff Res 2017; 6 (06) 529-536
    CrossrefPubMedGoogle Scholar
  • 34 Voon HY, Shafie AA, Bujang MA, Suharjono HN. Cost effectiveness analysis of carbetocin during cesarean section in a high volume maternity unit. J Obstet Gynaecol Res 2018; 44 (01) 109-116
    CrossrefPubMedGoogle Scholar