Adverse Effects of Carbetocin versus Oxytocin in the Prevention of Postpartum Haemorrhage after Caesarean Section: A Randomized Controlled Trial

Mannaerts, Dominique; Veeken, Lennart Van der; Coppejans, H.; Jacquemyn, Yves

doi:10.1155/2018/1374150

Cited by 25 publications

(30 citation statements)

References 13 publications

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“…Oxytocin can cause water retention and subsequent hyponatraemia, as the drug has a structural analogy with antidiuretic hormone (ADH; vasopressin), and therefore activates the ADH receptor . Oxytocin can cause nausea and vomiting; vomiting occurred in 15% of women after a 5 IU bolus followed by a 10 IU infusion over 24 h . This adverse effect is dose related, as nausea occurred in 5% vs. 33%, and vomiting in 2.5% vs. 15% of women after 2 IU or 5 IU oxytocin, respectively .…”

Section: Oxytocinmentioning

confidence: 99%

International consensus statement on the use of uterotonic agents during caesarean section

Heesen

Carvalho

et al. 2019

Anaesthesia

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Summary It is routine to give a uterotonic drug following delivery of the neonate during caesarean section. However, there is much heterogeneity in the relevant research, which has largely been performed in low‐risk elective cases or women with uncomplicated labour. This is reflected in considerable variation in clinical practice. There are significant differences between dose requirements during elective and intrapartum caesarean section. Standard recommended doses are higher than required, with the potential for acute cardiovascular adverse effects. We recommend a small initial bolus dose of oxytocin, followed by a titrated infusion. The recommended doses of oxytocin may have to be increased in women with risk factors for uterine atony. Carbetocin at equipotent doses to oxytocin has similar actions, while avoiding the requirement for a continuous infusion after the initial dose and reducing the need for additional uterotonics. As with oxytocin, carbetocin dose requirements are higher for intrapartum caesarean sections. A second‐line agent should be considered early if oxytocin/carbetocin fails to produce good uterine tone. Women with cardiac disease may be very sensitive to the adverse effects of oxytocin and other uterotonics, and their management needs to be individualised.

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Section: Oxytocinmentioning

confidence: 99%

International consensus statement on the use of uterotonic agents during caesarean section

Heesen

Carvalho

et al. 2019

Anaesthesia

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“…In this study, the adverse events attached to carbetocin are shown to be worse than adverse events attached to oxytocin. However, in the published literature, carbetocin is found to have a similar adverse events profile to oxytocin [ 6 , 7 ], and so in reality, carbetocin is likely to perform slightly better than suggested in Analysis 2.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of the carbetocin trials included in the NMA consist of a small sample population [ 16 ]. Carbetocin is the most effective strategy, and is known to have a favourable adverse event profile, similar to oxytocin [ 6 , 7 ]. However, carbetocin has a much higher unit cost than the other uterotonic drugs.…”

Section: Methodsmentioning

confidence: 99%

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Uterotonic Drugs for the Prevention of Postpartum Haemorrhage: A Cost-Effectiveness Analysis

Pickering

Gallos

Williams

et al. 2018

PharmacoEconomics Open

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Objective The objective of this study was to estimate the relative cost effectiveness for the full range of uterotonic drugs available for preventing postpartum haemorrhage (PPH). Methods A model-based economic evaluation was constructed using effectiveness data from a network meta-analysis, and supplemented by the literature. A UK National Health Service (NHS) perspective was adopted for the analysis, which is based on UK costs from published sources. The primary outcome measure is cost per case of PPH avoided (≥ 500 mL blood loss), with secondary outcome measures of cost per case of severe PPH avoided (≥ 1000 mL) and cost per major outcome (surgery) averted also being analysed. Results Carbetocin is shown to be the most effective strategy. Excluding adverse events, ‘ergometrine plus oxytocin’ was shown to be the least costly strategy. The incremental cost-effectiveness ratio for prevention of PPH with carbetocin compared with prevention with ‘ergometrine plus oxytocin’ was £1889 per case of PPH ≥ 500 mL avoided; £30,013 per case of PPH ≥ 1000 mL avoided; and £1,172,378 per major outcome averted. Including adverse events in the analysis showed oxytocin to be the least costly strategy. The incremental cost-effectiveness ratio for prevention of PPH with carbetocin compared with prevention with oxytocin was £928 per case of PPH ≥ 500 mL avoided; £22,900 per case of PPH ≥ 1000 mL avoided; and £894,514 per major outcome averted. Conclusion The results suggest carbetocin, oxytocin and ‘ergometrine plus oxytocin’ could all be favourable options for being the most cost-effective strategy for preventing PPH. Carbetocin could be the preferred choice, especially if the price of carbetocin decreased. Mixed findings mean a clear-cut conclusion cannot be made as to which uterotonic is the most cost effective. Future research should focus on collecting more robust evidence on the probability of having adverse events from the uterotonic drugs, and on adapting the model for low- and middle-income countries.

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“…A number of experimental and clinical data provided substantial evidence for hypotensive action of peripherally and centrally administered OT (16,36,44,45). For instance, Gutkowska et al (16) have shown that repeated subcutaneous injections of OT cause diurnal and nocturnal reductions of blood pressure in spontaneously hypertensive rats (SHR).…”

Section: Introductionmentioning

confidence: 99%

Impaired hypotensive effects of centrally acting oxytocin in SHR and WKY rats exposed to chronic mild stress

Wsol

Wojno

Puchalska

et al. 2020

American Journal of Physiology-Regulatory, Integrative and Comp

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The present study was designed to determine the role of centrally acting oxytocin (OT) in the regulation of blood pressure during chronic mild stress (CMS) in spontaneously hypertensive (SHR; n = 36) and normotensive Wistar-Kyoto (WKY; n = 38) rats. The rats were implanted with osmotic minipumps for intracerebroventricular infusions of 0.9% NaCl, OT, and oxytocin receptor antagonist (OTANT) and divided into two groups: SHR and WKY 1) exposed to 4-wk CMS and 2) not exposed to stress (controls). After 4 wk, hemodynamic parameters were recorded at rest and after an application of acute stressor [air-jet stress (AJS)]. Resting mean arterial blood pressure (MAP) was significantly lower in CMS-exposed SHR and WKY infused with OT than in the corresponding groups receiving saline. Exposure to CMS exaggerated the AJS-dependent pressor response in WKY receiving saline but not in the corresponding group of SHR. OT infusion reduced the AJS-dependent pressor response in both CMS-exposed and not exposed SHR and in CMS-exposed WKY. Intracerebroventricular infusion of OTANT potentiated the AJS-dependent pressor response in both stressed and not stressed WKY rats but not in SHR. The results show that centrally delivered OT decreases resting MAP during CMS in both SHR and WKY rats and that in SHR it reduces pressor responses to AJS under control and CMS conditions, whereas in WKY this effect is significant only after CMS exposure. The study indicates that endogenous centrally acting OT may play an essential role in buffering pressor responses to AJS in CMS-exposed and not exposed WKY rats and that this function is significantly impaired in SHR.

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Adverse Effects of Carbetocin versus Oxytocin in the Prevention of Postpartum Haemorrhage after Caesarean Section: A Randomized Controlled Trial

Cited by 25 publications

References 13 publications

International consensus statement on the use of uterotonic agents during caesarean section

International consensus statement on the use of uterotonic agents during caesarean section

Uterotonic Drugs for the Prevention of Postpartum Haemorrhage: A Cost-Effectiveness Analysis

Impaired hypotensive effects of centrally acting oxytocin in SHR and WKY rats exposed to chronic mild stress

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