Summary:
Background: Postpartum hemorrhage (PPH) is a
potentially life-threatening complication of both vaginal and
caesarean delivery. The most frequent cause of postpartum
hemorrhage is uterine atony, when the uterus fails to contract
fully after delivery of the placenta. For the prevention of
this uterine atony we need an effective uterotonic drug. Till
now oxytocin is used for enhancing uterine contraction after
delivery. But oxytocin has some limitations like shorter halflife,
less contraction time and more side effects, whereas
carbetocin has prolonged duration of action which ensures
more contraction time and less adverse effects. So,
carbetocin considered as a good alternative over oxytocin
for the prevention of primary PPH in caesarean section.
The Aim of Study: To see the efficacy and safety of
carbetocin over oxytocin for the prevention of primary PPH
during caesarean section.
Patients and Methods: A randomized-controlled trial was
conducted in the Institute of Child and Mother Health
(ICMH), Dhaka, Bangladesh over a period of nine months
from January to September 2016. Ninety-four patients who
had got admitted in ICMH undergoing caesarean section
at term were randomized into two groups receiving either
10IU oxytocin or 100µg carbetocin, after the operation.
Outcome measures such as primary PPH, massive blood
loss, need for additional uterotonic drug, additional blood
transfusion as well as adverse effects were all documented.
Results: This study had shown that carbetocin is superior
in comparison to oxytocin for the prevention of primary
PPH following caesarean section. Each patient obtained
either a single dose of 100 microgram carbetocin
intravenously or 10 IU of oxytocin during caesarean section.
Massive blood loss occurred in 6.4%patients, blood
transfusion needed in 17% patients and additional uterotonic
needed for 25.5% patients in oxytocin group but in
carbetocin group no massive blood loss occurred, only 2.1%
patient needed immediate blood transfusion and no patient
was required additional uterotonics. There were no major
adverse effects observed in both the groups. No patients
had developed PPH in carbetocin group. But 12.8% patients
had developed primary PPH in oxytocin group.
Conclusion: Carbetocin appears to be an effective new drug
than oxytocin for the prevention of primary postpartum
hemorrhage in caesarean section.
Key Words: Carbetocin, Oxytocin, Postpartum hemorrhage.
(J Bangladesh Coll Phys Surg 2019; 37: 19-24)