Management of 3rd stage of labour

1. Efficacy Of Carbetocin In The Management Of Third Stage Of Labor Following Vaginal Delivery
Aisha Mohamed Elbareg, Mohamed Omer Elmahashi, Fathi Mohamed Essadi
Obstetrics & Gynecology department, Misurata Central Hospital/ P O BOX: 2472.Misurata.Libya
Prevention of postpartum hemorrhage (PPH) is an important task in
improving health care of women. Syntometirne is an effective uterotonic
agent used in preventing PPH, but has a wide range of adverse effects.
Carbetocin is a long-acting oxytocin analogue with more pronounced
pharmacological effects. Its half life is prolonged and with less enzymatic
degradation. We assess and compare the effectiveness and safety of
Carbetocin & Syntometrine when they are administered following vaginal
delivery in preventing primary PPH.
Background & Objective
Subjects & Methods
Results
Table 1: Primary and Secondary outcome measures
Table 2: Adverse effects
Conclusion
A prospective study was conducted over a period of 3 months. A total of
200 pregnant women with no contraindication for vaginal delivery at 37
weeks or beyond were recruited. Exclusion criteria: history of heart
disease, hypertension, renal or liver disorders, preeclampsia, asthma,
placenta previa or abruption. Women were divided into two groups and
given either Carbetocin or Syntometrine as a single dose intramuscularly
(IM). Outcome measures such as blood loss, uterine tone, vital signs,
hemoglobin levels before delivery compared with those 24 hours
postpartum, the need for additional uterotonic therapy as well as
adverse effects were all documented.
References
1. Boucher M, Nimord CA, Tawagi GF, et al. comparison of carbetocin and oxytocin for the prevention of postpartum hemorrhage following vaginal delivery: a double-blind randomized trial. J Obstet Gynecol Can 2004;26:481-8
2. Leung SW, Ng PS, et al. A randomized trial of carbetocin versus syntometrine in the management of third stage of labor. BJOG 2006; 113: 1459-64
3. Askar AA, Ismail MT, et al. Carbetocin versus syntometrine in the management of third stage of labor following vaginal delivery . Arch Gynecol Obstet 2011; 284:1359-1365.
Single dose of IM Carbetocin (100μg) may be more
effective as compared to single IM Syntometrine in
preventing primary PPH and with a low incidence of
adverse effects. It can be considered as a good
alternative to other uterotonic agents in managing 3rd
stage of labor
Discussion
This study showed that using Carbetocin as a routine
uterotonic drug administered as part of the active
management of the third stage of labor is as effective
as Syntometrine but with a less adverse effect. The
difference was statistically highly significant in the
mean blood loss, mean fall in hemoglobin, incidence of
hypertension (blood pressure ≥140/90) at 30 minutes
after delivery. Comparable result was seen in term of
the need for additional uterotonic agents and the
incidence of postpartum hemorrhage. Although there
was a trend for Carbetocin to be associated with
reduced need for additional uterotonic agents, the
difference was not statistically significant. Carbetocin
has a lower incidence of adverse effects such as
nausea and vomiting but associated with higher
incidence of tachycardia (pulse ≥100 beats per minute
within 60 min after delivery.
significanceSyntometrine
N= 100
Carbetocin
N= 100
Variable
HS >0.001490.1±95.6260.6±110.6Mean blood loss
HS >0.0011.35±0.30.7±0.2Mean drop of HB
HS >0.0019 (9%)2 (2%)Use of uterotonics
NS
NS
3 (3%)
1 (1%)
2 (2%)
0 (0%)
1ry PPH >500ml
2ry PPH >1000 ml
significanceSyntometrine
N= 100
Carbetocin
N= 100
Variable
S13 (13%)4 (4%)Nausea
S14 (14%)3 (3%)Vomiting
HS >0.0019 (9%)2 (2%)Hypertension
Immediate after delivery
30 min after delivery
S12 (12%)21 (21%)Tachycardia