carbetocin and Uterine-Inertia

In Mexico, during 2010, obstetric hemorrhage was second (19.6%) as a direct cause of maternal death. The aim of this paper is to evaluate the effect of oxytocin and carbetocin, in preventing postpartum hemorrhage in patients with risk factors for uterine atony.. Study type clinical trial, patients experiencing at least one of the risk factors for uterine atony included. Randomly, they were divided into two groups: one was given Oxytocin and other received Carbetocin. The following variables were determined: risk factors for uterine atony, hemoglobin and hematocrit, vital signs, trans-surgical bleeding, whether or not presented uterine atony, uresis, need for additional tonics uterus and need for blood transfusion.. A total of 120 patients were studied in 6 months were excluded 3, 60 were treated with Carbetocin, and 57 with Oxytocin. It was determined that there is a greater number of events of uterine atony (p = 0.007, with RR 11.06) and therefore greater need for additional tonic uterus (p = 0.027, with RR 5.44) in the group of Oxytocin. There was no statistically significant difference in the other variables.. Carbetocin is recommended as prophylaxis of obstetric hemorrhage in patients with risk factors for uterine atony.. Introducción: en México, en 2010, la hemorragia obstétrica ocupó el segundo lugar (19.6%) como causa directa de muerte materna. El objetivo de este trabajo es evaluar el efecto de la oxitocina y la carbetocina, en la prevención de hemorragia posparto en pacientes con factores de riesgo para atonía uterina. Métodos: estudio tipo ensayo clínico, se incluyeron a pacientes que presentaron al menos uno de los factores de riesgo para atonía uterina. De manera aleatoria, se dividieron en dos grupos: a uno se le administró oxitocina y el otro recibió carbetocina. Se determinaron las siguientes variables: factores de riesgo para atonía uterina, hemoglobina y hematocrito, signos vitales, sangrado transquirúrgico, si presentó o no atonía uterina, uresis, necesidad de uterotónicos adicionales y necesidad de transfusión de hemoderivados. Resultados: se estudiaron un total de120 pacientes en 6 meses, se excluyeron 3, de las cuales 60 fueron tratadas con carbetocina y 57 con oxitocina. Se determinó que existe un mayor número de eventos de atonía uterina (p = 0.007, con RR de 11.06) y, por ende, mayor necesidad de uterotónico adicional (p = 0.027, con RR de 5.44), en el grupo de la oxitocina. No hubo diferencia estadísticamente significativa en el resto de las variables. Conclusiones: Se recomienda carbetocina como profilaxis de hemorragia obstétrica en pacientes con factores de riesgo para atonía uterina.

Topics: Adult; Double-Blind Method; Female; Humans; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Risk Factors; Treatment Outcome; Uterine Inertia

A randomized study involving pregnant women was conducted to compare the effectiveness of a single intravenous (IV) injection of carbetocin with that of a standard 2-h oxytocin IV infusion with respect to intraoperative blood loss in the prevention of uterine atony after cesarean section (CS). The two treatments also were compared for safety and ability to maintain adequate uterine tone and to reduce the incidence and severity of postpartum hemorrhage (PPH) in women at risk for this condition.. Between 1 September 2007 and 5 January 2008, we enrolled 104 patients with at least one risk factor for PPH undergoing CS in a randomized, controlled clinical trial. We compared the effect of a single 100 microg IV dose of carbetocin with that of a standard 2-h ten international units (IU) IV infusion of oxytocin. The primary outcome was the proportion of patients requiring additional oxytocic intervention for uterine atony. Fiftytwo women received 100 microg carbetocin IV immediately after placental delivery, while 52 women received 10 IU oxytocin IV infusion. Complete blood count was collected at entry and 24 h postpartum. All outcome measures, including the need for additional uterotonic agents or uterine massage, and blood loss, were analyzed using chi-square, Fisher exact, and Student's t tests.. A single 100 microg IV injection of carbetocin was as effective as a continuous 2-h infusion of oxytocin in controlling intraoperative blood loss after placental delivery. Mean blood loss after carbetocin administration was 30 ml less than after oxytocin administration (P = 0.5). The percentage of patients with blood loss < or =500 ml was greater with carbetocin (81 vs. 55%; P = 0.05). Carbetocin enhanced early postpartum uterine involution. The fundus was below the umbilicus in more patients who received carbetocin at 0, 2, 6, and 24 h on the ward (P < 0.05). The main additional uterotonic agent used was a further administration of oxytocin (20 IU in physiological solution 500 ml at an infusion rate of 200 ml/h). In the carbetocin group, 20 of the 52 women (38.4%) required at least one uterine massage compared to 30 of the 52 women (57.7%) in the oxytocin group (P < 0.01). Overall, uterotonic intervention was clinically indicated in two of the women (3.8%) receiving carbetocin compared to five of the women (9.6%) given an IV oxytocin infusion (P < 0.01). The odds ratio of treatment failure requiring oxytocic intervention was 1.83 (95% confidence interval, CI, 0.9-2.6) times higher in the oxytocin group compared with the carbetocin group.. Carbetocin makes possible to obtain, with a single IV injection, results equivalent to those of oxytocin on the maintenance of uterine tonicity and the limitation of blood losses, in the peri- and in the post-operative period, during a delivery by CS. It has in addition a comparable tolerance. Even in our series adverse events are practically of the same type and similar frequency in both study groups. Thus, the effectiveness of carbetocin consists, thanks to its long half-life, on an unique injection, whereas oxytocin requires repeated injections or a perfusion of several hours, with a variability of the administered doses.

Topics: Adult; Blood Cell Count; Cesarean Section; Double-Blind Method; Female; Humans; Injections, Intravenous; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Uterine Inertia; Young Adult

Carbetocin and oxytocin are commonly recommended agents for active management of the third stage of labour. Evidence is inconclusive whether either one more effectively reduces the occurrence of important postpartum haemorrhage outcomes at caesarean section. We examined whether carbetocin is associated with a lower risk of severe postpartum haemorrhage (blood loss ≥ 1000 ml) in comparison with oxytocin for the third stage of labour in women undergoing caesarean section. This was a retrospective cohort study among women undergoing scheduled or intrapartum caesarean section between 1 January 2010 and 2 July 2015 who received carbetocin or oxytocin for the third stage of labour. The primary outcome was severe postpartum haemorrhage. Secondary outcomes included blood transfusion, interventions, third stage complications and estimated blood loss. Outcomes were examined overall and by timing of birth, scheduled versus intrapartum, using propensity score-matched analysis. Among 21,027 eligible participants, 10,564 women who received carbetocin and 3836 women who received oxytocin at caesarean section were included in the analysis. Carbetocin was associated with a lower risk of severe postpartum haemorrhage overall (2.1% versus 3.3%; odds ratio, 0.62; 95% confidence interval 0.48 to 0.79;

Topics: Cesarean Section; Female; Humans; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Uterine Inertia

Twin pregnancy has a high risk for developing uterine atony (UA). This study aimed to evaluate efficacy and clinical outcomes of prophylactic compression sutures to treat UA during twin cesarean section (CS).. All patient records of twin deliveries by CS after gestational age of 24 weeks in a large maternity hospital in South Korea between January 2013 and June 2018 were reviewed. Patients with monochorionic monoamniotic twins were excluded from data analysis. In total, 953 women were eligible for data analysis.. Of the 953 patients, compression sutures were applied to 147 cases with postpartum bleeding that were refractory to uterine massage and uterotonics. Out of the 147, two patients (1.4%) proceeded to additional uterine artery ligation to achieve hemostasis, yielding a success rate of 98.6%. The rate of transfusion after the first 24 h of delivery in the suture group was not significantly different from that in the non-suture group, suggesting that both groups achieved hemostasis at an equal rate after the first 24 h of delivery. The difference in the operation time between the two groups was only 8.5 min. The rate of subsequent pregnancy among the patients who received compression sutures was 44.4%.. Overall, our findings suggest that with early and fast implementation of compression sutures, UA can be treated in the setting of twin cesarean delivery without significantly increasing maternal morbidity.

Topics: Adult; Blood Transfusion; Cesarean Section; Dinoprostone; Female; Hemostasis, Surgical; Humans; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Pregnancy, Twin; Suture Techniques; Treatment Outcome; Uterine Artery Embolization; Uterine Inertia

 To assess the cost-effectiveness of carbetocin versus oxytocin for prevention of postpartum hemorrhage (PPH) due to uterine atony after vaginal delivery/cesarean section in women with risk factors for bleeding..  A decision tree was developed for vaginal delivery and another one for cesarean, in which a sequential analysis of the results was obtained with the use of carbetocin and oxytocin for prevention of PPH and related consequences. A third-party payer perspective was used; only direct medical costs were considered. Incremental costs and effectiveness in terms of quality-adjusted life years (QALYs) were evaluated for a one-year time horizon. The costs were expressed in 2016 Colombian pesos (1 USD = 3,051 Col$)..  In the vaginal delivery model, the average cost of care for a patient receiving prophylaxis with uterotonic agents was Col$ 347,750 with carbetocin and Col$ 262,491 with oxytocin, while the QALYs were 0.9980 and 0.9979, respectively. The incremental cost-effectiveness ratio is above the cost-effectiveness threshold adopted by Colombia. In the model developed for cesarean section, the average cost of a patient receiving prophylaxis with uterotonics was Col$ 461,750 with carbetocin, and Col$ 481,866 with oxytocin, and the QALYs were 0.9959 and 0.9926, respectively. Carbetocin has lower cost and is more effective, with a saving of Col$ 94,887 per avoided hemorrhagic event..  In case of elective cesarean delivery, carbetocin is a dominant alternative in the prevention of PPH compared with oxytocin; however, it presents higher costs than oxytocin, with similar effectiveness, in cases of vaginal delivery..  Avaliar a relação custo-eficácia da carbetocina versus oxitocina para prevenção de hemorragia pós-parto (HPP) vaginal e cesariana devido à atonia uterina em mulheres com fatores de risco para desenvolver sangramento. MéTODOS:  Foram desenvolvidos protocolos de manejo para parto vaginal e outra para parto por cesárea e analisados resultados obtidos com carbetocina e oxitocina na prevenção de HPP, assim como, consequências relacionadas à ocorrência do evento hemorrágico. A perspectiva utilizada foi a do terceiro pagador, portanto, apenas os custos médicos diretos foram levados em consideração. Os custos incrementais e a eficácia em termos de anos de vida ajustados pela qualidade (QALY) foram avaliados para um horizonte de tempo de um ano. Os custos foram expressos em pesos colombianos de 2016 (1 USD = 3.051 Col$)..  No modelo de parto vaginal, o custo médio de cuidados para um paciente que recebeu profilaxia com agentes uterotônicos foi de Col$ 347.750 com carbetocina e Col$ 262.491 com oxitocina, enquanto os QALYs foram 0,9980 e 0,9979, respectivamente. O índice incremental de custo-efetividade está acima do limite de custo-efetividade adotado pela Colômbia. No modelo desenvolvido para parto por cesárea, o custo médio do paciente que recebeu profilaxia com terapia uterotônica foi de Col$ 461.750 com carbetocina e Col$ 481.866 com oxitocina e os QALYs foram 0,9959 e 0,9926, respectivamente. A carbetocina foi a alternativa com menor custo e maior efetividade com uma economia de $94.887 por evento hemorrágico evitado. CONCLUSãO:  A carbetocina no parto eletivo por cesárea é uma alternativa dominante na prevenção da PPH em relação à oxitocina; porém representa custos mais altos com uma eficácia similar à da oxitocina no caso de parto vaginal.

Topics: Colombia; Cost-Benefit Analysis; Decision Support Techniques; Female; Humans; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Risk Assessment; Uterine Inertia

The aim of this study was to compare the costs of using carbetocin in the prevention of uterine atony following delivery of the infant by Cesarean section (C-section) under epidural or spinal anesthesia with standard methods of prevention (SMP).. This retrospective multicenter study was based on data from three medical centers. A questionnaire was developed to gather patient records on consumption and costs of resources related to C-section, prevention of uterine atony and postpartum hemorrhage (PPH) treatment. Six subpopulations were considered, depending on patient characteristics. The analysis covered two perspectives: that of the hospital and of the public payer.. The subpopulations were homogenous, which was a premise for pooling the data. The use of carbetocin in the prevention of uterine atony following Cesarean section generates savings for hospital in comparison with SMP (oxytocin) in 5 of 6 subpopulations. The biggest savings were observed amongst patients who experienced severe PPH and reached 2.6-6.2 thousand PLN per patient. Costs of services related to C-section borne by the hospitals were higher than the refund received from a public payer. The greatest underestimation reached 12.1 thousand PLN per patient. Nevertheless, loss generated by this underfunding was lower in carbetocin versus oxytocin group.. The use of carbetocin instead of SMP gives hospitals an opportunity to make savings as well as to reduce losses resulting from the underfunding of the services provided by the National Health Fund.

Topics: Adult; Anesthesia, Epidural; Anesthesia, Spinal; Cesarean Section; Drug Costs; Female; Humans; Oxytocics; Oxytocin; Postoperative Complications; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Uterine Inertia

The aim of the study was to compare the effectiveness of carbetocin and oxytocin for prevention of postpartum hemorrhage (PPH) after caesarean section.. We analyzed data from 279 patients who received 100 μg of carbetocin intravenously or 10 IU of oxytocin into the uterine muscle as a rudimentary treatment for prevention of PPH.. Blood loss was statistically significantly higher (p=0.0136) in the entire study group as compared to the oxytocin group, and in cases when additional uterotonics were administered (p=0.0090). Also, we observed a statistically significantly correlation between the need for additional treatment and patient BMI. Patients with pre-pregnancy BMI of ≥25 more often required additional medicaments after administration of carbetocin as compared to oxytocin (p=0.0077). We noted a statistically significantly higher rate of using additional treatment (p<0.05) after administering oxytocin into the uterine muscle as compared to intravenously given carbetocin (75% vs. 33%, respectively).. 1. Carbetocin is more effective than oxytocin in the prevention of PPH and significantly reduces the necessity to administer therapeutic uterotonics during caesarean delivery. 2. Higher rates of additional treatment with uterotonics after the administration of carbetocin as compared to oxytocin in a group of patients after2 or more cesarean sections and women with BMI of ≥25 require further studies in a target-selected larger sample size. 3. Based on our findings, it is not possible to conclude that 100 μg of intravenous carbetocin is more effective than 10 IU of oxytocin given to the uterine muscle during caesarean delivery to prevent PPH.

Topics: Adult; Cesarean Section; Delayed-Action Preparations; Dose-Response Relationship, Drug; Female; Humans; Injections, Intravenous; Oxytocin; Perinatal Care; Postpartum Hemorrhage; Pregnancy; Uterine Inertia; Young Adult

The aim of the study was to compare the prophylactic effects of carbetocin with those of oxytocin for the prevention of uterine atony in patients undergoing elective caesarean section (CS) in the Netherlands. The primary endpoint was the need for additional uterotonic medication.. Each of the five participating Dutch hospitals treated 50-100 term patients with 100 μg of intravenous carbetocin on prescription. Each centre retrieved charts of 250 patients treated with oxytocin according to the hospital's policy for the prevention of uterine atony (oxytocin bolus 5 IU, bolus 10 IU or bolus 5 IU followed by 10 IU in 2 h).. In the carbetocin group 462 subjects were included and in the oxytocin group 1,122. The proportion of subjects needing additional uterotonic treatment was 3.1 % (95 % CI 1.7-5.1 %) after carbetocin and 7.2 % (5.8-8.9 %) after oxytocin; relative risk 0.41 (0.19-0.85); p = 0.0110. Carbetocin was most effective compared with the oxytocin 5 IU bolus subgroup with less need for additional uterotonic medication (3.1 vs. 9.3 %, p = 0.0067) and blood transfusions (2.2 vs. 3.6 %, p = 0.0357).. Compared with oxytocin, prophylaxis of uterine atony with carbetocin after an elective CS diminished the need for additional uterotonics by more than 50 %.

Topics: Adult; Cesarean Section; Dose-Response Relationship, Drug; Female; Gestational Age; Humans; Injections, Intravenous; Netherlands; Oxytocics; Oxytocin; Pregnancy; Treatment Outcome; Uterine Inertia

The administration of oxytocic drugs during caesarean section is an important intervention to prevent uterine atony or treat established postpartum haemorrhage. Considerable past and current research has shown that these agents have a narrow therapeutic range. A detailed knowledge by anaesthetists of optimal doses and side effects is therefore required. Oxytocin remains the first line agent. In view of receptor desensitisation, second line agents may be required, namely ergot alkaloids and prostaglandins. This review examines the adverse haemodynamic and side effects, and methods for their limitation. An approach to dosing and choices of agent for the limitation of postpartum haemorrhage is suggested.

Topics: Adult; Cesarean Section; Ergonovine; Ergot Alkaloids; Female; Humans; Oxytocics; Oxytocin; Postoperative Nausea and Vomiting; Pregnancy; Prostaglandins; Uterine Diseases; Uterine Inertia

To compare the efficacy of carbetocin versus oxytocin, during delivery in patients undergoing a caesarian section.. A two phase observational study (before/after design) was conducted. Use of carbetocin was considered as a sentinel event. Data for 155 women who received carbetocin during a caesarian section were compared with 155 patients who received oxytocin. The main parameter evaluated was the need for haemostatic surgical techniques (vascular sutures, uterine compression sutures, emergent hysterectomy) during caesarian section.. Both populations were comparable, particularly concerning risk factors of postpartum haemorrhage. In the carbetocin group, there was fewer compression sutures during caesarian section (0.6% versus 4.5%, P=0.06), as well as a significant decrease in postoperative intravenous iron administration (6.5% versus 14.5%, P=0.03). Vascular sutures, frequencies of prostaglandin intravenous injections, and blood transfusions during caesarian section were similar in both populations. There wasn't any emergent hysterectomy during the time of this study.. Prevention of uterine atony during a caesarian section with carbetocin seems to be as effective as oxytocin. Particularly, decreasing rate of surgical compression sutures with use of carbetocin is not significant, and prospective studies with more patients are necessary to confirm these results.

Topics: Adult; Cesarean Section; Cohort Studies; Delayed-Action Preparations; Female; Hemostatic Techniques; Humans; Iron; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Treatment Outcome; Uterine Inertia