carboxyprogesterone is more effective in management of third stage of labour than oxytocin..

1. JOURNAL CLUB
PRESENTOR—Dr PRUDVI
MODERATOR– Dr.NUI DARANG

2. CARBOPROST VERSUS OXYTOCIN FOR
ACTIVE MANAGEMENT OF THIRD STAGE OF
LABOUR
• Sunil Kumar KS, Sundar Shyam, Pavitra Batakurki.
• Federation of Obstetric & Gynecological societies of
India 2016

3. INTRODUCTION
• Third stage of labour is the most crucial stage.
• Active management of third stage of labour play an
important role in reducing maternal mortality and
morbidity due to PPH.
• Average duration -15mins in both primi and
multigravida.
• Maternal mortaliy rate – 212 per 100,000 livebirths in
India.
• Among these 30% are due to post partum hemorrhage

4. • Postpartum hemorrhage -- dreaded complication
• Post partum hemorrhage is one of the most important
causes for maternal deaths world wide, uterine atony
seen in 70 – 90% of the cases.
• Drugs used for prophylaxis PPH – carboprost
tromethamine, methyl ergometrine, oxytocin and
syntometrin.
• This demonstrates the difference in efficacy of
oxytocin and carboprost in prevention of post partum
hemorrhage.

5. AIMS AND OBJECTIVES:
• To evaluate the scope of using prophylactic
intramuscular carboprost tromethamine 125 mcg in
comparision with intramuscular oxytocin 10 units for
active management of 3rd stage of labour

6. MATERIALS AND METHODS
• Type of study – A Prospective randomized control
study.
• Place of study – Department of obstetrics &
gynecology at SDM college medical sciences and
hospital, sattur, Dharwad, Karnataka, India.
• Study period – november 2011 to october 2012.
• Study population – 200 pregnant women
• Study group – 2 groups

7. INCLUSION CRITERIA –
Pregnant women at term with spontaneous onset
of labour.
EXCLUSION CRITERIA :
• Women with:
– Hypersensitivity to drugs
– Asthma,
– Cardiac diseases,
– Epilepsy,
– Psychiatric disorders,
– Liver and Renal diseases

8. METHODOLOGY
200 (total no of
samples)
Group A
(100)
GROUP B
(100)
Serially numbered
envelopes
10 units im
oxytocin given
125 mcg im
carboprost given
Given immediately after the delivery
of the anterior shoulder of baby

9. Outcomes:
• Duration of third stage of labour
• Blood loss –calibrated brass v obstetric drape
• Additional uterotonics
• Complications
• Side effects
• Hemoglobin – measured 24hours after delivery .

10. RESULTS

11. OUTCOME GROUP A GROUP B STATISTICAL
ANALYSIS
DURATION OF
THIRD STAGE OF
LABOUR
7.02 6.05 P= 0.002
BLOOD LOSS(ml) 281 170 P=<0.0001
ADDITIONAL USE
OF UTEROTONICS
(%)
21 04 P=<0.001
NO. OF CASES HAD
PPH
7 3 P=0.19
NO. OF CASES
REQUIRED BLOOD
TRASFUSSION
2 0 P=0.15
MEAN DIFFERENCE
IN HEMOGLOBIN
BEFORE AND AFTER
DELIVERY IN g/dl
0.57 0.4 P=0.99
MATERNAL
MORTALITY
0 0 -

12. SIDE EFFECTS GROUP A GROUP B RELATIVE RISK( %)
NAUSEA 2 2 P=1.00 RR=1
VOMITING 0 2 P=0.29 RR=5
SHIVERING 2 4 P=0.4 RR2
DIARRHOEA 1 8 P=0.04 RR=8
TEMPERATURE
>37.5 C
1 2 P=0.5 RR=2

13. Statistics
• Unpaired t test
• Chi-square test

14. Discusssion
• In group A 21%were needed additional uterotonics ,
whereas in group B only only 4% received additional
uterotonics.
• There are no studies that compared mean duration of
3rd stage of labour between carboprost and oxytocin.
• Few studies have compared carboprost with
syntometrine which donot show any difference in
mean blood loss.

15. • Few studies have examined the usefulness of
prophylactic dose of carboprost in prevention of PPH
with promising results.
• Vaid et al. compared prophylactic sublingual
misoprostol, intramuscular methyl ergometrine and
intramuscular carboprost , found equally effective in
prevention of PPH.

16. • Abdel-Aleem et al. compared carboprost and methyl
ergometrine and observed duration of third stage of
labour and mean blood loss were significantly less
with carboprost.
• Yet another study was done by jing Bhai et al, which
demonstrated median blood loss is significantly lower
in carboprost group compared to oxytocin for high
risk patients undergoing cesearian section.

17. CONCLUSION
• Study emphasizes that carboprost is more effective
compared to oxytocin in active management of third
stage of labour.
• Carboprost shortens the duration of third stage of
labour without the need of additional uterotonics.
• It can be used in all patients including hypertensives.

18. limitations
• Done at single centre
• Very minimal study population.
• Results from this study may not be relied for
larger group.
• Carboprost needs to be stored at 2-4 degree
celsius and may not be readily available in all
centres.

19. THANK YOU