Effectiveness and safety of carboxytocin versus oxytocin in preventing postpartum hemorrhage: A systematic review and meta‐analysis

Abstract

Objective: This study compared the effectiveness and safety of carbetocin and oxytocin in preventing postpartum hemorrhage (PPH). Methods: A systematic literature search was performed on PubMed, Embase, and the Cochrane Library for relevant studies published up to February 2019. Next, two independent reviewers screened the studies according to the selection criteria as well as the strategies recommended by the Cochrane Collaboration. Data were then extracted and evaluated. All statistical analyses were performed using RevMan 5.1. Results: A total of 24 studies involving 37 383 patients were included for analysis. For cesarean section patients, carbetocin was superior to oxytocin in reduction of the need for additional uterine contraction (odds ratio [OR] = 0.48, 95% confidence interval [CI] [0.35, 0.65], p < 0.00001), PPH (OR = 0.70, 95% CI [0.51, 0.95], p = 0.02), blood loss (mean [MD] = À64.36, 95% CI [À107.78, À20.93], p = 0.004), and transfusion (OR = 0.59, 95% CI [0.42, 0.82], p = 0.002), and there was no significant difference in severe PPH (OR = 0.84, 95% CI [0.66, 1.090], p = 0.19). For vaginal delivery patients, carbetocin was superior to oxytocin in reduction of the need for additional uterine contractions (OR = 0.48, 95% CI [0.25, 0.93], p = 0.03), PPH (OR = 0.28, 95% CI [0.09, 0.91], p = 0.03), and blood loss (MD = À63.52, 95% CI [À113.43, À13.60], p = 0.01), and there were no significant differences in severe PPH (OR = 0.82, 95% CI [0.40, 1.69], p = 0.59) and transfusion (OR = 0.60, 95% CI [0.22, 1.61], p = 0.31). With regard to safety, for cesarean section patients, carbetocin was superior to oxytocin in reduction of the incidence of headache (OR = 0.72, [0.55, 0.95], p = 0.02), and there were no significant differences in nausea, vomiting, abdominal pain, flushing, tremors, itching, dizziness, and fever. For vaginal delivery patients, there were no significant differences in nausea, vomiting, headache, abdominal pain, flushing, tremors, itching, dizziness, and fever between the two drugs. Conclusion: For patients undergoing cesarean section and vaginal delivery, carbetocin was superior to oxytocin in effectiveness and similar in safety. Therefore, carbetocin is expected to be an alternative uterine contraction agent for preventing PPH.

Modeling the economic burden of postpartum hemorrhage due to substandard uterotonics in Ghana

“…Heat-stable carbetocin has shown similar efficacy and adverse events profile to oxytocin within the CHAMPION trial [ 34 , 35 ]. Moreover, in a meta-analysis, heat-stable carbetocin has been found to have similar safety and superior effectiveness compared to oxytocin [ 36 ]. Unfortunately, heat-stable carbetocin is not widely available and costs slightly more per dose than oxytocin [ 35 ].…”

Carbetocin Versus Oxytocin Following Vaginal and Cesarean Delivery: A Before-After Study

“…Interestingly, results of initial studies and the first meta-analysis stated that there remained some uncertainty as to the effectiveness of carbetocin 1 but with the growing number of studies, the difference became more obvious and at least 2 recent metaanalyses showed a benefit in favor of carbetocin. 2,3 So, How Can One Explain the Present Results?…”

“…Regarding cesarean delivery, there have been several well-performed comparisons between the 2 drugs which results have been included into meta-analyses and overall the information gathered from these studies shows that both drugs are effective and that carbetocin is at least as effective than oxytocin, and likely better. Interestingly, results of initial studies and the first meta-analysis stated that there remained some uncertainty as to the effectiveness of carbetocin1 but with the growing number of studies, the difference became more obvious and at least 2 recent meta-analyses showed a benefit in favor of carbetocin 2,3…”

Comparative study of room temperature stable carbetocin verses oxytocin for the prevention of PPH in caesarean section

“…In the present study, all the participants who had received Carbetocin as intervention had blood loss within normal limits while among those who had received oxytocin, 76% had blood loss within normal limits, 14% had little excess blood loss and 10% had excess blood loss. Sun H et al (2022) in a systematic review reported that the volume of blood loss to be significantly lowered when Carbetocin was used in the place of Oxytocin. The observation made was similar to the observation in the present study [10] .…”

“…Sun H et al (2022) in a systematic review reported that the volume of blood loss to be significantly lowered when Carbetocin was used in the place of Oxytocin. The observation made was similar to the observation in the present study [10] . Gursoy A et al (2021) also reported similar result of diminished blood loss volume in the Carbetocin group than the Oxytocin one [12] .…”