A Comparative Randomised Controlled Trial In The Use Of Intra Muscular Carbetocin Vs Intra Muscular Oxytocin In The Prevention Of Postpartum Haemorrhage During Cesarean Section And Blood Loss Estimation

Abstract

Introduction:

Globally, postpartum hemorrhage (PPH) is a significant factor in maternal mortality and morbidity. It has been demonstrated that actively managing the third stage of labor can effectively prevent PPH. A long-acting oxytocin agonist called carbetocin seems to be a promising treatment for PPH.

AIMS AND OBJECTIVES:

To evaluate the efficacy and safety of intramuscular carbetocin in comparison to oxytocin for prevention of postpartum hemorrhage in women undergoing cesarean delivery.

Materials and Methods:

100 women with singleton pregnancies without any ante-natal complications in the age group 18 to 40years presenting at 34-42 weeks of gestation, consented to participate in this study and were followed up till delivery. Patients and their relatives were explained on the nature of study procedure, benefits and side effects. Written informed consent obtained from patients who were willing to participate in the trial in the prescribed format in the regional language (Tamil) prior to any procedure being performed related to the study. The demographic details of the patients were collected. History recorded from patients, particularly menstrual, marital and obstetric history. Vitals were recorded, General, Systemic, obstetric and vaginal examination were done. Fetal heart rate monitored regularly. Laboratory investigations performed. Patients who fulfil the inclusion and exclusion criteria were enrolled and randomized by simple randomisation to either

test group(carbetocin) or control group(oxytocin). Blood loss was estimated by various methods.

Results:

96% of cases in carbetocin group had blood loss associated with 100-150ml and 96% of cases in oxytocin group had blood loss between 150-200ml.

2% of cases in oxytocin group and none in carbetocin group had blood transfusion which is not statistically significant (p=0.082)

Similarly in both study groups HB levels before and after 2hr and 24hr apart from delivery were similar confirming no significant difference in blood loss level although we found a tendentially lower Hb decrease at 12h from delivery in carbetocin group.

None from carbetocin group vS 6% (3) from oxytocin group needed additional uetrotonics. Hence significantly more women required additional uterotonic agents in oxytocin group (p<0.01).

Difference between mean blood loss between 2 groups was 51ml, statistically significant. (p=0.020)

Conclusion:

We propose that visual estimation of postpartum blood loss be withdrawn from standard obstetric practice and replaced with a more appropriate method, such as objective measurement using a sterile under-buttock drape.

We conclude that a single intra muscular injection of carbetocin appears to be more effective than intramuscular injecton of oxytocin to maintain adequate uterine tone, with a similar safety profile and minor antidiuretic effect.