carbetocin and Uterine-Hemorrhage

To evaluate uterine contractility, bleeding, haemodynamic performance, and side effects of different doses of oxytocin after delivery under spinal anaesthesia in caesarean section without prior labour in childbirth. We also perform a pharmacoeconomic evaluation.. A randomised, descriptive, observational and multicentre prospective study was conducted, which included 104 ASA 1 patients divided into 3 groups. Group 1 (n=52) received after removal of the foetus and coinciding with foetal umbilical cord clamping, 1 IU of oxytocin followed by an infusion of 2.5 UI×h(-1); Group 2 (n=52) a continuous infusion of 20IU oxytocin at a rate of 700mUI×min(-1) followed later by 10UI×h(-1), and group 3, 100μg bolus dose of carbetocin only.. There were no statistical differences between groups in anthropometric, obstetric or anaesthetic variables. Significant differences in uterine contraction in vaginal bleeding and the incidence of side effects, particularly headache and tremor, were more pronounced in the carbetocin group.. With these results, we cannot recommend the routine use of carbetocin in caesarean sections, because it is accompanied by an increased incidence of side effects without any improvement in the prevention of obstetric haemorrhage. Finally, it is economically more expensive than the use of low doses of oxytocin, which may be the trend that should be considered in the future, due to the clinical outcomes, and its lower cost.

Topics: Adult; Algorithms; Cesarean Section; Elective Surgical Procedures; Female; Humans; Oxytocics; Oxytocin; Pregnancy; Prospective Studies; Uterine Hemorrhage

in Mexico, obstetric hemorrhage and its complications are the second leading cause of maternal death and is the origin of irreversible functional consequences. Carbetocin is a synthetic analogue of oxytocin with an average lifespan four times that of oxytocin and pharmacological effects of 120 minutes produces a tonic contraction which reduces postpartum blood loss.. To evaluate the usefulness of carbetocin to prevent uterine bleeding complications and maternal deaths and assess the benefits, effectiveness and side effects.. Prospective, observational clinical research in two phases, the first from May 2005 to January 2006 with a sample of 40 patients and the second from January to December of 2008 with a sample of 72 patients conducted at the Hospital Materno Infantil Dr. Alberto López Hermosa, San Luis Potosi. All were high-risk pregnancies and medical complications that warranted specialty hospital management. The intervention consisted of applying undiluted single dose of 100 micrograms of intravenous carbetocin at the time of delivery, as prophylaxis in patients with uterine overdistention in the first phase of the study and complicated pregnancies in the second phase.. Were born by caesarean section over 60%. Initially, the hemoglobin showed a reduction of 17% after delivery. Seven patients required blood transfusion (17.5%). In the second phase, 65 patients (90%) did not require transfusion, only 6 patients (8%) required transfusion. No side effects were documented. Uterine overdistension was the main risk factor for bleeding and transfusion.. Carbetocin combines the safety of oxytocin and the strength of the ergonovine preparations. To determine where carbetocin will be situated in the future as an useful oxytocic, it requires more than a simple demonstration of its effectiveness. This should be determined in each clinical situation, with factors such as overdistended uterus, indicating the convenience and economic constraints.

Topics: Adult; Blood Loss, Surgical; Blood Transfusion; Cesarean Section; Contraception; Female; Humans; Hysterectomy; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications; Pregnancy, High-Risk; Prospective Studies; Uterine Contraction; Uterine Hemorrhage; Young Adult

Maternal mortality is a public health problem reflecting lack of infrastructure in health facilities or poor obstetrical training of those caring for pregnant women.. To report the results of a comprehensive program of the Health System of San Luis Potosi State, aimed at reducing maternal mortality in the period 2004-2008.. An observational and retrospective study based on information provided by the State Committee for the Study and Prevention of Maternal Mortality in the 58 municipalities, hospitals and medical units of the state of San Luis Potosi.. During the period 2004-2008, maternal mortality was reduced by 55% as a result of increased postpartum contraception coverage from 32 to 74% in general and community hospitals, and from 47 to 58% in health care units located in risk areas. In 2004, births fell by 5.8%. Between 1990 and 2003, 2,929 newborns were left maternal orphans, with an annual average of 209. During the study period, 423 infants were in the same situation, with an average of 70.. The present conditions of the social environment of San Luis Potosi are favourable to further reduce maternal mortality.

Topics: Child, Orphaned; Contraception; Female; Government Programs; Health Policy; Humans; Infant, Newborn; Maternal Health Services; Maternal Mortality; Mexico; Oxytocin; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Retrospective Studies; Rural Population; Uterine Contraction; Uterine Hemorrhage