Carbetocin versus Oxytocin in Active Management of 3rd stage of Labour following Vaginal Delivery

Abstract

Background: Every day more than 220 women around the world die from severe bleeding after childbirth. Globally post-partum hemorrhage is the number one direct cause of maternal mortality. Most postpartum hemorrhages are caused by uterine atony and occur in the immediate postpartum period. Most of these tragic deaths can be prevented by active management of third stage of labour. Active management of the third stage of labor should be practiced routinely to decrease the risk of postpartum hemorrhage. Oxytocin is used for enhancing uterine contraction after delivery. But oxytocin has some limitations like shorter half- life, less contraction time and more side effects, whereas carbetocin has prolonged duration of action which ensures more contraction time and less adverse effects. This study was done to see the efficacy and safety of carbetocin over oxytocin for prevention of PPH after vaginal delivery.
 Methodology: A randomized controlled clinical trial was conducted in the Department of Obstetrics and Gynecology, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh over a period of 9 months from January 2015 to September 2015. Ninety four patients undergoing vaginal delivery at term were randomized into two groups receiving either 10IU oxytocin or 100 μg carbetocin. Outcome measures such as primary PPH, massive blood loss, need for additional uterotonic drug, additional blood transfusion as well as adverse effects were documented.
 Results: In this study, massive blood loss did not occur none of patients in carbetocin group. But massive blood loss occured 6.4% women of oxytocin group. Further fundal massage , immediate blood transfusion and additional uterotonics didn’t need any patient in carbetocin group. In oxytocin group, fundal massage required in 8.5% of women, blood transfusion needed in 10.6% patients and additional uterotonics needed in 10.6% women. Average amount of blood loss was 88 ml less in carbetocin group and adverse effects of drugs were almost similar in both group. Primary PPH developed in oxytocin group 8.5% but none of patients had developed PPH in carbetocin group.
 Conclusion: Carbetocin is an effective new drug than oxytocin for prevention of postpartum hemorrhage in vaginal delivery.
 Bioresearch Commu. 7(1): 927-931, 2021 (January)

Carbetocin versus oxytocin in primigravida for active management of third stage of labor: a prospective study

“…12 Ashraf et al documented mean ages of 23.9±3.2 years for the carbetocin group and 23.3±3.2 years for the oxytocin group, providing additional perspectives on the age distribution in these interventions. 13 In the current study, the mean age within group A was 24.9±3.7 years, while in group B, it was 24.5±3.8 years. Notably, Reyes and Gonzalez et al found that participants in the carbetocin group had a mean age of 26.5 years, while those in the oxytocin group had a mean age of 26.7 years.…”

“…In contrast, the oxytocin group exhibited higher rates, with 15.5% and 10.6% requiring blood transfusion in separate studies. 13,14 In the current study, none of the patients in group A necessitated fundal massage, while in group B, 9% of patients required it. This trend is consistent with the findings of Ashraf et al 13 Moreover, Agnes et al observed that 10% of patients in the carbetocin group and 83% in the oxytocin group required fundal massage, highlighting a notable difference in the demand for this intervention between the two drug groups.…”

“…13,14 In the current study, none of the patients in group A necessitated fundal massage, while in group B, 9% of patients required it. This trend is consistent with the findings of Ashraf et al 13 Moreover, Agnes et al observed that 10% of patients in the carbetocin group and 83% in the oxytocin group required fundal massage, highlighting a notable difference in the demand for this intervention between the two drug groups. 15 In this study, 8% of patients in group A required additional uterotonic agents, whereas in the oxytocin group, 15% of patients needed such supplementation.…”

“…12 Ashraf et al reported mean ages of 23.9±3.2 years and 23.3±3.2 years for the carbetocin and oxytocin groups, respectively, contributing further insights into the age profiles associated with these interventions. 13 In the current study, the gestational age emerged as a highly significant factor, with group A and group B exhibiting gestational ages of 38.02±1.5 and 39.00±1.8 weeks, respectively. Correspondingly, Maged et al found that the average gestational ages were 39.4±1.3 weeks in the carbetocin group and 39.2±1.4 weeks in the oxytocin group, closely mirroring the findings of this study.…”

“…of significant differences between study groups concerning incidence of adverse effects associated with both drugs. 8,13 In this study, none of the patients in group A required blood transfusion, whereas in group B, 2% of patients needed blood transfusion. These findings align with others, where none of the women in the carbetocin group necessitated blood transfusion.…”