Is Carbetocin More Effective than Oxytocin for PPH Prevention During Elective Cesarean?
BACKGROUND AND PURPOSE:
Evidence that carbetocin may be superior to oxytocin for PPH prevention is based on data from mixed populations and it is unclear if the results would be similar for women delivering in an elective setting rather than emergent
Onwochei et al. (International Journal of Obstetric Anesthesia, 2019) compared carbetocin to oxytocin during elective cesarean delivery
Systematic review and meta-analysis
Study needed to include comparison of carbetocin against oxytocin for elective cesarean delivery
Need for additional uterotonics
Mean blood loss
Need for blood transfusion
Incidence of PPH >1000 mL
9 studies | 1962 patients
IV carbetocin 100 µg used in all studies and was compared to single bolus dose IV oxytocin 5 IU in three of the studies while other studies assessed oxytocin bolus with infusion of varying strengths and duration
Need for additional uterotonics was reduced with carbetocin vs oxytocin (P<0.001)
Odds ratio (OR) 0.47 (95% CI, 0.34 to 0.64)
The number needed to treat was 11
There was no statistical difference in reported blood loss
Prevention of PPH: Inconclusive due to
Risk of bias | Data heterogeneity | Inconsistency in reporting bleeding outcomes
The risk for additional uterotonic administration was reduced by 53% with carbetocin compared to oxytocin in elective cesarean delivery
The authors recommend standardizing bleeding-related outcomes in future studies
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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