Int J Gynaecol Obstet. 2023 Feb 23. doi: 10.1002/ijgo.14743. Online ahead of print.
ABSTRACT
OBJECTIVE: To compare the effectiveness of prophylactic carbetocin with prophylactic oxytocin for preventing severe postpartum hemorrhage (PPH) following vaginal delivery.
METHODS: This before-and-after cohort study took place between 2020-2021 in a university maternity hospital. In 2021, protocol for PPH prevention immediately after vaginal delivery changed: oxytocin (5IU)IV was replaced by carbetocin (100μg)IV. All patients with vaginal births were included, with two groups compared: patients who received prophylactic oxytocin in 2020 and those who received prophylactic carbetocin in 2021. The primary outcome was severe PPH, defined as one or more of the following: estimated blood loss ≥ 1500 mL, transfusion≥4 units of red blood cells, Bakri balloon use, embolization, vascular ligation, hysterectomy, maternal death.
RESULTS: Among 4832 women included: 2417 received oxytocin and 2415 carbetocin. The rate of severe PPH was similar in both groups (0.5% vs 0.6%; aOR 0.8; 95% CI 0.4-1.8). The rate of PPH ≥ 500 mL was lower in the carbetocin group (4% versus 5.8%; P = 0.004).
CONCLUSION: Although prophylactic carbetocin was associated with a reduction in the rate of PPH ≥ 500 mL, carbotocin is non-inferiors to oxytocine at preventing severe post-partum hemorrhage due atony after vaginal delivery.
PMID:36825331 | DOI:10.1002/ijgo.14743
