Carbetocin for preventing postpartum haemorrhage

Su, Linlin; Chong, Yap‐Seng; Melamed, Samuel

doi:10.1002/14651858.cd005457.pub4

Cited by 92 publications

(90 citation statements)

References 34 publications

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“…This results in sustained uterine contractions for over an hour and obviates the need to maintain uterine tone with additional oxytocic infusion . It can also be administered either as slow intravenous injection or intramuscularly, although the latter has not received approval from the United States Food and Drug Administration . Meta‐analysis has shown that when compared to oxytocin, carbetocin reduced the need for additional uterotonics.…”

Section: Introductionmentioning

confidence: 99%

“…Meta‐analysis has shown that when compared to oxytocin, carbetocin reduced the need for additional uterotonics. This may translate into savings in terms of lower staffing time taken to monitor and administer the additional medication . From a practical point of view, a newer formulation of carbetocin that is stable under room temperature has been developed and this would widen its appeal, especially in settings where cold chain poses a challenge.…”

Section: Introductionmentioning

confidence: 99%

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Cost effectiveness analysis of carbetocin during cesarean section in a high volume maternity unit

Voon¹,

Shafie

Bujang

et al. 2017

J of Obstet and Gynaecol

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AimTo evaluate the cost effectiveness of carbetocin compared to oxytocin when used as prophylaxis against post‐partum hemorrhage (PPH) during cesarean deliveries.MethodsA systematic review of the literature was performed to identify randomized controlled trials that compared the use of carbetocin to oxytocin in the context of cesarean deliveries. Cost effectiveness analysis was then performed using secondary data from the perspective of a maternity unit within the Malaysian Ministry of Health, over a 24 h time period.ResultsSeven randomized controlled trials with over 2000 patients comparing carbetocin with oxytocin during cesarean section were identified. The use of carbetocin in our center, which has an average of 3000 cesarean deliveries annually, would have prevented 108 episodes of PPH, 104 episodes of transfusion and reduced the need for additional uterotonics in 455 patients. The incremental cost effectiveness ratio of carbetocin for averting an episode of PPH was US$278.70.ConclusionReduction in retreatment, staffing requirements, transfusion and potential medication errors mitigates the higher index cost of carbetocin. From a pharmacoeconomic perspective, in the context of cesarean section, carbetocin was cost effective as prophylaxis against PPH. Ultimately, the relative value placed on the outcomes above and the individual unit's resources would influence the choice of uterotonic.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost effectiveness analysis of carbetocin during cesarean section in a high volume maternity unit

Voon¹,

Shafie

Bujang

et al. 2017

J of Obstet and Gynaecol

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“…A recent Cochrane review reported that carbetocin decreased significantly the use of additional uterotonic agents in women undergoing cesarean delivery when compared to oxytocin (RR, 0.64; 95% CI, 0.51 to 0.81; four trials, 1173 women). 61 There were no differences between carbetocin and oxytocin in postpartum hemorrhage >500 mL and >1000 ml, intraoperative blood loss, blood transfusion, decrease in hemoglobin, and adverse effects. Our systematic review and meta-analysis showed that the combined use of sublingual misoprostol and oxytocin was superior to oxytocin alone, because the combination significantly reduced the need for additional uterotonic agents by 67% (RR, 0.33; 95% CI, 0.18 to 0.62).…”

Section: Commentmentioning

confidence: 78%

Misoprostol to reduce intraoperative and postoperative hemorrhage during cesarean delivery: a systematic review and metaanalysis

Conde-Agudelo

Díaz

Rosas-Bermúdez

et al. 2013

American Journal of Obstetrics and Gynecology

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OBJECTIVE To evaluate the efficacy and safety of prophylactic misoprostol use at cesarean delivery for reducing intraoperative and postoperative hemorrhage. STUDY DESIGN Systematic review and meta-analysis of randomized controlled trials. RESULTS Seventeen studies (3174 women) were included of which 7 evaluated misoprostol versus oxytocin and 8 evaluated misoprostol plus oxytocin versus oxytocin. Overall, there were no significant differences in intraoperative and postoperative hemorrhage between sublingual or oral misoprostol and oxytocin. Rectal misoprostol, compared with oxytocin, was associated with a significant reduction in intraoperative and postoperative hemorrhage. The combined use of sublingual misoprostol and oxytocin, compared with the use of oxytocin alone, was associated with a significant reduction in the mean decrease in hematocrit (mean difference, −2.1%; 95% confidence interval [CI], −3.4 to −0.8) and use of additional uterotonic agents (relative risk, 0.33; 95% CI, 0.18-0.62). Compared with oxytocin alone, buccal misoprostol plus oxytocin reduced the use of additional uterotonic agents; rectal misoprostol plus oxytocin decreased intraoperative and postoperative blood loss, mean fall in hematocrit, and use of additional uterotonic agents; and intrauterine misoprostol plus oxytocin reduced the mean fall in hemoglobin and hematocrit. Women receiving misoprostol, alone or combined with oxytocin, had a higher risk of shivering and pyrexia. CONCLUSION Misoprostol combined with oxytocin appears to be more effective than oxytocin alone in reducing intraoperative and postoperative hemorrhage during caesarean section. There were no significant differences in intraoperative and postoperative hemorrhage when misoprostol was compared to oxytocin. However, these findings were based on a few trials with methodological limitations.

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“…The appropriate dose is 100 μg by slow intravenous route. The scientific evidence has shown no differences in the prevention of PPH, only an improvement in relation to the use of additional uterotonics [7].…”

Section: T's Etiology Risk Factormentioning

confidence: 99%

Massive Postpartum Hemorrhage: Protocol and Red Code

Masip¹,

Almeida-Toledano²,

Ferrero-Martínez³

et al. 2017

Obstetrics

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Postpartum hemorrhage (PPH) is the leading cause of maternal death. In developing countries, approximately 8% of maternal death is caused by PPH. Protocols should provide a standardized approach to evaluate and monitor the patients. A standard protocol must be recognized by the institution and must be accepted and known by all team members. Additionally, it is important to have a massive obstetric hemorrhage protocol (red code) for those patients with an important bleeding who require blood products available as soon as possible. In the red code activation protocol there are several key points to consider: the management algorithm must be known and accepted by all team members, a clear and effective communication between the team must be established and all the participants must know the role they play. Massive obstetric hemorrhage has a multidisciplinary implication: obstetricians, anesthesiologists, pediatricians, midwife, nurses, auxiliary staff, and laboratory blood bank staff. The active participation of the multidisciplinary team in simulations before the protocols implementation facilitates the evaluation of critical points and subsequent changes before their final application, the assessment of the adequacy of circuits and infrastructure, as well as a better protocols compliance.

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Carbetocin for preventing postpartum haemorrhage

Cited by 92 publications

References 34 publications

Cost effectiveness analysis of carbetocin during cesarean section in a high volume maternity unit

Cost effectiveness analysis of carbetocin during cesarean section in a high volume maternity unit

Misoprostol to reduce intraoperative and postoperative hemorrhage during cesarean delivery: a systematic review and metaanalysis

Massive Postpartum Hemorrhage: Protocol and Red Code

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