Carboprost Versus Oxytocin for Active Management of Third Stage of Labor: A Prospective Randomized Control Study

Abstract

Background and Objectives Postpartum hemorrhage is the single largest and leading cause of maternal morbidity and mortality not only in developing countries but also in developed countries. The present study is an attempt to evaluate the scope of using prophylactic intramuscular carboprost tromethamine 125 lg in comparison with intramuscular oxytocin 10 units for the active management of third stage of labor. Materials and Methods Two hundred pregnant women at term with spontaneous onset of labor were included in the study and were randomly divided into 2 groups of 100 women each. Group A and group B were given injection oxytocin 10 units and injection carboprost tromethamine 125 lg intramuscularly, respectively, at the time of delivery of anterior shoulder. The main outcome measures with respect to third stage of labor were: duration, blood loss by volume, difference in hemoglobin, need for additional oxytocics and side effects. Results Subjects who received carboprost tromethamine 125 lg showed a significant reduction in duration of third stage of labor (p \ 0.05) and blood loss (p \ 0.01) when compared to the subjects who received oxytocin 10 units.

Side‐effects of carbetocin to prevent postpartum hemorrhage: A systematic review and meta‐analysis of randomized controlled trials

“…Sensitivity analysis by excluding a dose of 125 ug carbetocin trial 15 showed that the results were not substantial influenced, and they were just slight changes. Funnel plots and Begger's and Egger's tests found no significant publication bias.…”

“…Except for Sunil Kumar KS’s article (125 ug), 15 all articles performed a standard dose of 100 ug carbetocin. The articles were conducted in various countries.…”

“…High risk of bias was mostly attributed to incomplete outcome data and other bias, such as granting by the pharmaceutical company and the failure to declare potential conflicts of interest. Meanwhile, performance and detection bias existed in one article 15 . In general, the quality was good, with five high‐quality articles, twelve moderate quality articles, and none of the articles was classified as low quality (Figures 2, 3).…”

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

“…Carboprost can cause significant bronchospasm, even in patients without asthma . Other effects include hypertension, diarrhoea, nausea, vomiting, flushing, hyperpyrexia and myalgia . Sulprostone may cause fever, diarrhoea and painful uterine contraction .…”

Prostaglandin E2 and F2alpha Modulate Urinary Bladder Urothelium, Lamina Propria and Detrusor Contractility via the FP Receptor

“…Generally, activation of EP1 and EP3 receptors is associated with an excitatory response, whereas EP2 and EP4 are associated with inhibition of smooth muscle contractility ( Woodward et al, 2011 ). Furthermore, clinical uses of the prostaglandin E 2 agonist dinoprostone, include the stimulation of uterine smooth muscle contractions during labor ( Stephenson and Wing, 2015 ) with the prostaglandin F 2α agonist, carboprost, being a viable alternative to oxytocin during the management of labor ( Sunil Kumar et al, 2016 ). Therefore, the involvement of EP1, EP3 and FP receptors is of particular interest in the modulation of lower urinary tract contractility due to their excitatory effect when stimulated.…”