Intramuscular oxytocin versus Syntometrine^® versus carbetocin for prevention of primary postpartum haemorrhage after vaginal birth: a randomised double‐blinded clinical trial of effectiveness, side effects and quality of life

Abstract

Objective To compare intramuscular oxytocin, Syntometrine® and carbetocin for prevention of postpartum haemorrhage after vaginal birth. Design Randomised double‐blinded clinical trial. Setting Six hospitals in England. Population A total of 5929 normotensive women having a singleton vaginal birth. Methods Randomisation when birth was imminent. Main outcome measures Primary: use of additional uterotonic agents. Secondary: weighed blood loss, transfusion, manual removal of placenta, adverse effects, quality of life. Results Participants receiving additional uterotonics: 368 (19.5%) oxytocin, 298 (15.6%) Syntometrine and 364 (19.1%) carbetocin. When pairwise comparisons were made: women receiving carbetocin were significantly more likely to receive additional uterotonics than those receiving Syntometrine (odds ratio [OR] 1.28, 95% CI 1.08–1.51, P = 0.004); the difference between carbetocin and oxytocin was non‐significant (P = 0.78); Participants receiving Syntometrine were significantly less likely to receive additional uterotonics than those receiving oxytocin (OR 0.75, 95% CI 0.65–0.91, P = 0.002). Non‐inferiority between carbetocin and Syntometrine was not shown. Use of Syntometrine reduced non‐drug PPH treatments compared with oxytocin (OR 0.64, 95% CI 0.42–0.97) but not carbetocin (P = 0.64). Rates of PPH and blood transfusion were not different. Syntometrine was associated with an increase in maternal adverse effects and reduced ability of the mother to bond with her baby. Conclusions Non‐inferiority of carbetocin to Syntometrine was not shown. Carbetocin is not significantly different to oxytocin for use of additional uterotonics. Use of Syntometrine reduced use of additional uterotonics and need for non‐drug PPH treatments compared with oxytocin. Increased maternal adverse effects are a disadvantage of Syntometrine. Tweetable abstract IM carbetocin does not reduce additional uterotonic use compared with IM Syntometrine or oxytocin.

Effectiveness of prophylactic carbetocin versus oxytocin following vaginal delivery for preventing severe postpartum hemorrhage

“…The results of this study, which show no difference between carbetocin and oxytocin in the prevention of severe PPH, are difficult to compare with the existing literature since few studies have evaluated the prophylactic use of carbetocin after vaginal delivery in similar high-income countries. These studies are limited [9][10][11] mainly by concerns regarding control groups, which vary between studies and by the outcomes examined. These studies have small sample sizes that lack the statistical power to show differences, and the populations are heterogeneous; some studies include both vaginal and cesarean deliveries.…”

“…Nonetheless, studies are required to analyze its effectiveness in different care settings that may be associated with different levels of risk. The few studies conducted in high-income countries have shown that the effectiveness of carbetocin after vaginal delivery is similar to oxytocin for preventing PPH [8][9][10] and probably for reducing the use of second-line treatment for PPH. 11 However, these studies have some limitations, including debatable and variable outcomes depending on the study, failure to evaluate more severe maternal morbidity, small sample sizes, and different interventions in control groups with the use of different uterotonics (substances, doses, and routes of administration).…”

Peripartum Haemorrhage, Diagnosis and Therapy. Guideline of the DGGG, OEGGG and SGGG (S2k, AWMF Registry No. 015-063, August 2022)

“…References: [79,80] 4.1. Reference: [26] 5 General (emergency) measures and diagnostic steps to determine causes…”

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

“…7 While the use of carbetocin after vaginal deliveries has shown promise in high-income countries several studies underscore certain limitations. [8][9][10] DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20240460 Department of Obstetrics and Gynaecology, Al-Ameen Medical College and Hospital, Vijayapur, Karnataka, India These include variability in outcomes depending on the study, inadequate assessment of severe maternal morbidity, small sample sizes, and variations in interventions within control groups, encompassing different uterotonics, doses, and routes of administration. 11 The rationale for conducting this study lies in the critical importance of addressing PPH, a leading cause of maternal mortality worldwide.…”