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Advances in Social Sciences Research Journal – Vol.7, No.7

Publication Date: July 25, 2020

DOI:10.14738/assrj.77.8666.

Emarah, M. S. A. (2020). Carbetocin Or Oxytocin To Prevent Postpartum Haemorrhage Due To Uterine Aony In Cases Of Elective

Caesarean Section. Advances in Social Sciences Research Journal, 7(7) 739-745.

Carbetocin Or Oxytocin To Prevent Postpartum Haemorrhage Due

To Uterine Aony In Cases Of Elective Caesarean Section

Mohamed S. A. Emarah

Department, Obstetrics and Gynaecology,

Benha Teaching Hospital, Egypt.

ABSTRACT

Background: Despite the technological advancement made in the past

few decades, postpartum haemorrhage (PPH) remains one of the

principal causes of maternal deaths in developing nations. The

administration of uterotonic drugs widely prevents the PPH; therefore,

it is the main point of active management. Among uterotonics, oxytocin

has proven to be very effective in reducing the incidence of PPH. One

prophylactic drug which has been introduced in recent times is

carbetocin, a synthetic long-acting oxytocin analogue. It has a longer half

life of 41 min, allowing it to stimulate a prolonged uterine response of

up to an hour after a single intravenous dose, obviating the need for

infusion. Methods: A total of 120 pregnant women divided into two

groups; Group I (Carbetocin group) included 60 women who received

carbetocin and delivered by caesarean section (CS), Group II (Oxytocin

group) included 60 women who received oxytocin and delivered by

caesarean section (CS). Results: Our result showed that, there was a

statistically significant difference for the prevention of atonic

postpartum hemorrhage between the two groups (p<0.01), for

carbetocin group. There was also a statistically significant difference

between the two groups (p < 0.01), according to need to additional

procedures, such as need to modified B-lynch sutures and need to

bilateral uterine arteries ligation for carbetocin group. Conclusion: We

concluded that carbetocin was a better alternative to traditional

oxytocin in the prevention of PPH after elective caesarean section.

INTRODUCTION

Despite the technological advancement made in the past few decades, postpartum haemorrhage

(PPH) remains one of the principal causes of maternal deaths in developing nations(1).

PPH is responsible for one – fourth of maternal deaths worldwide. PPH is defined as postpartum

blood loss 500ml after vaginal delivery and blood loss > 1000 ml after caesarean delivery. Uterine

atony is the most common cause of PPH. Active management of the third stage of labor (AMTSL) is

recommended for prevention of PPH(2).

Administration of uterotonic agents is an essential component of AMTSL, as this prophylactic

strategy has decreased the incidence of PPH by nearly the half(3).

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Advances in Social Sciences Research Journal (ASSRJ) Vol.7, Issue 7, July-2020

100 g of carbetocin/ml as a single direct slowly intravenous (IV) injection and cases in the oxytocin

group were given, 10 international units (IU) of oxytocin (Syntocinon, Novartis Pharma AG, Basel,

Switzerland) slowly direct intravenous (IV) injection.

Need to additional procedures such as modified B-lynch sutures or Bilateral Uterine Arteries

Ligation were done, in cases progressed to PPH, due to uterine atony inspite of giving the

uterotonics carbetocin or oxytocin. These additional procedures were recorded in both groups.

Maternal blood pressure was measured before CS and checked immediately after giving the

uterotonic drug, then 30 minutes and 60 minutes later. Pulse was measured before CS and

rechecked 60 minutes after the end of CS. Blood was sampled for haemoglobin and platelet count

before CS and then rechecked 24 hours after CS. For the safety of both drugs used on liver and

kidney functions, blood was withdrawn for AST, ALT and creatinine 24 hours after the end of CS.

Statistical analysis was performed using SPSS version 19.0 (SPSS Inc., Chicago, IL, USA). Descriptive

statistics were used to describe variables; percent, proportion for qualitative variables. Mean, SD,

range for Quantitative variables. Comparison between groups was done using Chi-Square test for

qualitative variables, independent t – test for quantitative variables p values with significance of

less that 0.05% were considered statistically significant.

RESULTS

Table (1): Shows that, there were no statistically significant difference between the two groups for

all demographic variables.

Variable Drug Mean

(SD)

(no) or (%) P value

Age (years)

Carbetocin 30.68

(8.41)

0.965

Oxytocin 30.78

(8.46)

Parity

Carbetocin Nulliparous 29 (48.3 %)

0.714

Mulliparous 31 (51.7 %)

Oxytocin

Nulliparous 27 (45.0 %)

Mulliparous 33 (55.0 %)

BMI

(kg/m2)

Carbetocin 20.997

(4.791)

0.933

Oxytocin 21.280

(4.876)

Gestational age

(weeks)

Carbetocin 38.29

(0.92)

0.877

Oxytocin 38.31

(0.93)

Birth weight

(grams)

Carbetocin 2959.83

(387.71)

0.981

Oxytocin 2963.67

(339.53)

Table (2): Shows that, there was a statistically significant difference between the two groups for the

prevention of postpartum haemorrhage (p < 0.01) for carbetocin group.

Variable Drug (no) or (%) P value

Postpartum

hemorrhage

Carbetocin 3 (5 %) 0.01

Oxytocin 12 (20 %)