Carbetocin for the prevention of postpartum hemorrhage: a systematic review and meta-analysis of randomized controlled trials

Jin, Bohong; Du, Yongming; Zhang, Fubin; Zhang, Kemei; Wang, Lulu; Cui, Lining

doi:10.3109/14767058.2014.1002394

Cited by 42 publications

(29 citation statements)

References 19 publications

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“…Of the 29 systematic reviews, 18 Cochrane systematic reviews and 11 non-Cochrane systematic reviews were analysed: five studies examining active management of the third stage of labour [ 21 , 23 , 47 – 49 ], eight examining the use of oxytocin [ 24 – 29 , 50 , 51 ], seven examining the use of prostaglandin [ 30 – 32 , 52 – 55 ], one examining the use of ergot alkaloids [ 33 ], five examining tranexamic acid [ 56 – 60 ], one examining timing of umbilical cord clamping [ 22 ], one examining uterine massage [ 61 ], and one examining breastfeeding or nipple stimulation [ 62 ]. The participants in these reviews had undergone caesarean or vaginal deliveries.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 20 reviews examining blood loss > 1000 mL were identified: four regarding active management of the third stage of labour [ 21 , 23 , 47 , 48 ], six examining the use of oxytocin [ 24 , 27 – 29 , 50 , 51 ], four examining the use of prostaglandins [ 32 , 52 – 54 ], one examining the use of ergot alkaloids [ 33 ], three examining the use of tranexamic acid [ 56 , 59 , 60 ], one examining the timing of clamping umbilical cord [ 22 ], and one examining uterine massage [ 61 ]. Table 4 only displays interventions that compared the intervention with placebo or contrasting management.…”

Section: Resultsmentioning

confidence: 99%

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Prophylactic management of postpartum haemorrhage in the third stage of labour: an overview of systematic reviews

et al. 2018

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BackgroundPostpartum haemorrhage is a direct cause of maternal death worldwide and usually occurs during the third stage of labour. Most women receive some type of prophylactic management, which may include pharmacological or non-pharmacological interventions. The objective of this study was to summarize systematic reviews that assessed the effects of postpartum haemorrhage prophylactic management during the third stage of labour.MethodsWe applied the guidelines for conducting an overview of reviews from the Cochrane Handbook for Systematic Reviews of Interventions. We searched MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews to identify all relevant systematic reviews of randomized controlled trials of prophylactic management of postpartum haemorrhage in the third stage of labour compared with no treatment, placebo, or another management technique. Two review authors independently extracted data and assessed methodological quality using a measurement tool to assess reviews and quality of evidence using the Grades of Recommendation, Assessment, Development, and Evaluation for primary outcomes, summarizing results narratively.ResultsWe identified 29 systematic reviews: 18 Cochrane and 11 non-Cochrane. Cochrane systematic reviews were high quality, while the quality of non-Cochrane systematic reviews varied. The following techniques suggested effective, third-stage interventions to reduce the incidence of severe postpartum haemorrhage: active management of the third stage of labour compared to physiological management, active management compared to expectant management, administration of oxytocin compared to placebo, and use of tranexamic acid compared to placebo. The following third-stage management approaches reduced the need for blood transfusion: active management compared to physiological management, active management compared to expectant management, oral misoprostol compared to placebo, and tranexamic acid compared to placebo.ConclusionsNo effective prophylactic management techniques were identified for maternal mortality. Most methods of effective prophylactic management of postpartum haemorrhage were supported by evidence; however, they were limited to low- or moderate-quality evidence, and high-quality studies are therefore needed. Outcome measures of the included systematic reviews varied. It is recommended that outcome measures in preventive postpartum haemorrhage intervention trials align with the World Health Organization guidelines.Systematic review registrationPROSPERO: CRD42016049220.Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0817-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Prophylactic management of postpartum haemorrhage in the third stage of labour: an overview of systematic reviews

et al. 2018

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“…3 Choice between both products will be guided by other determinants including side effects and cost. Some studies did note a difference in the need for additional uterotonics when using carbetocin as compared to oxytocin, but these have used oxytocin in more a dilute solution or stopped the oxytocin intravenous administration very shortly after delivery.…”

Section: Discussionmentioning

confidence: 99%

“…In a systematic review and meta-analysis of randomized controlled trials carbetocin is associated with reduced need for additional uterotonic agents but no differences are noted for PPH, severe PPH, mean estimated blood loss nor adverse effects. 3 Side effects including nausea and vomiting or arterial hypotension eventually resulting in dizziness or even syncope have only been studied as secondary endpoints of randomized controlled trials. Hypotension has been reported as an important medical event in randomized trials, a hypotensive effect has been described both by oxytocin and carbetocin in randomized studies comparing carbetocin with oxytocin mainly on hemodynamic effects.…”

Section: Introductionmentioning

confidence: 99%

Protocol for a randomized trial on nausea, vomitus and arterial hypotension comparing carbetocin and oxytocin as prevention for hemorrhage after cesarean section

et al. 2017

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Background: To prevent hemorrhage after cesarean section uterotonics are often administered after fetal extraction. At this moment two frequently used and available products are short working oxytocin and its long working analogue, carbetocin. Both have proven and similar efficacy. Side effects are nausea, vomitus and arterial hypotension resulting in dizziness. Differences in nausea, vomitus and blood pressure changes between oxytocin and carbetocin have been studied as secondary outcome measures only and results have been conflicting. The aim of the present study is to compare nausea, vomiting and changes in blood pressure between carbetocin and oxytocin used as prevention for postpartum hemorrhage after cesarean section. Methods: Patients are women undergoing a planned term cesarean section for singleton pregnancy without other medical complications. One hundred patients will be randomized to receive either a single intravenous dose of 100 microgram carbetocin, either an intravenous bolus of 5 units of oxytocin followed by 10 units of oxytocin over 24 hours. As primary outcome nausea and vomitus are evaluated before, during and immediately after surgery, using a standard scale, blood pressure is automatically measured every three minutes. Secondary outcome measures are the difference between pre- and postoperative hemoglobin and the need for additional uterotonics. Analysis will be based on intention to treat.Conclusions: This study will offer data on the difference in clinically relevant side effects between carbetocin and oxytocin helping clinicians to choose between both products in low risk cesarean sections.

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“…4 Currently, other pharmacologic agents such as carbetocin are under investigation, aiming to overcome or simplify this approach of 2-phase oxytocin administration. 5,6 The relevance of deciding on the ideal dose definitely stems from the side effects and safety profile, which must be carefully considered for best practice as oxytocin is one of the 12 drugs included in the List of HighAlert Medications in Acute Care Settings by the Institute for Safe Medication Practices in the United States. 7 Similar practice warnings have been issued by the Food and Drug Administration in the United States and Confidential Enquiries into Maternal Deaths Report in the United Kingdom.…”

Section: Comment By William Camann MDmentioning

confidence: 99%

A Randomized, Double-blinded Trial of a “Rule of Threes” Algorithm Versus Continuous Infusion of Oxytocin During Elective Cesarean Delivery

Kovacheva¹,

Soens²,

Tsen³

2016

Obstetric Anesthesia Digest

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Carbetocin for the prevention of postpartum hemorrhage: a systematic review and meta-analysis of randomized controlled trials

Cited by 42 publications

References 19 publications

Prophylactic management of postpartum haemorrhage in the third stage of labour: an overview of systematic reviews

Prophylactic management of postpartum haemorrhage in the third stage of labour: an overview of systematic reviews

Protocol for a randomized trial on nausea, vomitus and arterial hypotension comparing carbetocin and oxytocin as prevention for hemorrhage after cesarean section

A Randomized, Double-blinded Trial of a “Rule of Threes” Algorithm Versus Continuous Infusion of Oxytocin During Elective Cesarean Delivery

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