Carbetocin versus intra‐umbilical oxytocin in the management of retained placenta: A randomized clinical study

Abstract

Aim: This study aimed to compare the hemodynamic profile and efficacy of carbetocin versus intra-umbilical oxytocin in the management of retained placenta following vaginal delivery. Material and Methods: In this randomized clinical study, women with retained placenta for more than 30 min were assigned to receive either an i.v. bolus of 100-μg carbetocin (n = 38) or an intra-umbilical vein injection of 50 IU oxytocin in 30 mL saline (n = 40). The main parameters evaluated were the success rate for expulsion of the placenta and the effects of these drugs on maternal blood pressure. Results: The success rate in the carbetocin group was 86.84% compared to 77.5% in the intra-umbilical oxytocin group. Notably, 57.7% of the participants had prior induction of labor or augmentation during labor. There were no significant differences between the two groups regarding the estimated blood loss, drop of hemoglobin within the first 48 h, additional uterotonic injection or the need for manual removal of the placenta. Systolic blood pressure was significantly lower in the intra-umbilical oxytocin group at 30 and 60 min after injection (P = 0.008, 0.026, respectively). Nonetheless, diastolic blood pressure was significantly lower in the intra-umbilical oxytocin group than in the carbetocin group at 30 min (P = 0.036). Conclusion: A single i.v. bolus of carbetocin and umbilical vein injection of 50 IU oxytocin are similarly effective in reducing the need for manual removal of the placenta. Carbetocin seems to have an acceptable hemodynamic safety profile and can be used as an alternative choice to the conventional oxytocic agents in the management of retained placenta.

Comparison of carbetocin and oxytocin infusions in reducing the requirement for additional uterotonics or procedures in women at increased risk of postpartum haemorrhage after Caesarean section

“…18 Carbetocin can shorten the third stage, prevent and treat retained placenta at term, and prevent and treat second trimester abortion. 19 However, our results were inconsistent with the findings of a previous study, in which the additional effects of carbetocin were presumed to be trivial because of thinning in the lower uterine myometrium, thereby reducing the immunoreactivity of oxytocin receptors relative to the upper part of the uterus. 20 We noted that the significant differences in outcomes between treatments were mainly due to the contributions of the emergency Caesarean section group.…”

Effect of Intra Umbilical Vein (IUV) Injection of Oxytocic Agents on Outcome of the Third Stage of Labor: A Meta-analysis

“…[1,9,16,17] In this meta-analysis, we included nine trials to compare IUV injection route with conventional IM and IV routes for administration of oxytocic agents. Of which, four trials compared IUV versus IV oxytocin, [6,[12][13][14] two trials compared IUV oxytocin with © 2019 IJNR | Published by Innovational Publishers IV carbetocin, [5,11] and three trials compared IUV versus IM oxytocin. [4,7,15] The trials comparing IUV oxytocin with IV oxytocin found compelling evidence that IUV oxytocin is associated with a statistically significant reduction in duration of the third stage of labor, reduction in amount of blood loss in the third stage of labor, and low placental separation time.…”

“…All included studies were hospital-based and conducted in labor room and labor operation theater. The studies included pregnant women undergoing normal vaginal delivery or cesarean delivery and with a sample size ranging from 78 [11] to 400. [4] Among the articles included in the analysis, four studies compared IUV oxytocin with IV oxytocin, [6,[12][13][14] which favored IUV oxytocin administration for comparatively short length of the third stage of labor, less amount of blood loss, and less time needed for placental expulsion.…”

“…[4] Among the articles included in the analysis, four studies compared IUV oxytocin with IV oxytocin, [6,[12][13][14] which favored IUV oxytocin administration for comparatively short length of the third stage of labor, less amount of blood loss, and less time needed for placental expulsion. Two studies compared IUV oxytocin with IV carbetocin, [5,11] and these studies have not reported statistically significant differences for outcomes of the third stage of labor. Three studies compared IUV oxytocin with IM oxytocin, [4,7,15] of which two studies [4,15] favor IUV oxytocin comparative to IM oxytocin for less time of the third stage of labor and less blood loss in the third stage of labor, but result of one study [7] shows contradictory results for these two outcomes.…”

“…No study has reported the potential side effects of the drugs and route of administration. The studies were conducted in India, [4,6] Pakistan, [13] Nepal, [7] Iran, [12] Russia, [15] Saudi Arabia, [11] Egypt, [5] and Sri Lanka. [14] Effects of interventions…”