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Grand Rounds

Is Carbetocin More Effective than Oxytocin for PPH Prevention During Elective Cesarean?

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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

METHODS:

  • Systematic review and meta-analysis
  • Inclusion criteria
    • RCTs
    • Study needed to include comparison of carbetocin against oxytocin for elective cesarean delivery
  • Primary outcome
    • Need for additional uterotonics
  • Secondary outcomes
    • Mean blood loss
    • Need for blood transfusion
    • Incidence of PPH >1000 mL

RESULTS:

  • 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

CONCLUSION:

  • 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

Learn More – Primary Sources:

Carbetocin reduces the need for additional uterotonics in elective caesarean delivery: a systematic review, meta-analysis and trial sequential analysis of randomised controlled trials

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Related ObG Topics:

Heat Stable Carbetocin: A Heat-Stable Alternative to Oxytocin?
Latest Cochrane Review: What is the Most Effective Prophylactic Treatment for Postpartum Hemorrhage?
Cochrane Review 2018: Uterotonic Agents for PPH Prophylaxis

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