Search

Objective: Our study's primary objective was to examine the effects of four different prophylactic protocols on the prevention of postpartum hemorrhage following vaginal birth, including carbetocin only, oxytocin only, and a combination of carbetocin or oxytocin with tranexamic acid. Design: A multicentric randomized controlled trial. Participants/Materials, Setting, and Methods: This multicentric center prospective randomized controlled trial was conducted at the Department of Obstetrics and Gynecology of Bezmialem University and Van Health Teaching and Research Hospital from August 2022 to January 2023. The collected data included age, gravidity, parity, gestational age at birth, duration of delivery stages, prepartum hemoglobin and hematocrit concentrations, changes in hemoglobin and hematocrit concentrations, intrapartum blood loss, estimated blood loss after 2 h of vaginal delivery, Apgar scores at 1 and 5 min, birth weight, and neonatal intensive care unit (NICU) admission. Intrapartum blood loss was objectively measured in milliliters using a postpartum drape with a calibrated bag. The amount of bleeding was measured by subtracting the empty weight of the pads placed under the patient in the patient's bed within 2 h after delivery. Group I: carbetocin 100 μg/mL (n = 75), group II: oxytocin 5 IU/mL (n = 75), group III: carbetocin and tranexamic acid 50 mg/mL (n = 75), group IV: oxytocin and tranexamic acid (n = 75). Results: The hemoglobin concentration decrease significantly differed between groups (1.03 ± 1.04, 1.3 ± 0.85, 1.4 ± 0.85, 1.41 ± 0.87, respectively; p < 0.001). Group 4 has the highest decrease in hemoglobin and hematocrit concentrations. When we investigated the subgroup differences, the decrease in hemoglobin concentration was significantly higher in group 2 than group 1 (1.30 ± 0.85 vs. 1.03 ± 1.04; p = 0.023), in group 2 than group 3 (1.3 ± 0.85 vs. 1.04 ± 0.9; p = 0.013), and in group 4 than group 3 (1.41 ± 0.87 vs. 1.04 ± 0.9; p < 0.001). The decrease in hematocrit level was significantly different between groups (3.07 ± 3.23, 3.55 ± 2.44, 2.13 ± 3.09, 4.25 ± 2.52; p < 0.001, respectively). No significant differences were observed in terms of mean blood loss between the four groups (277.19 ± 208.10, 294.13 ± 198.64, 274.33 ± 199.57, and 283.97 ± 178.11; p = 0.445, respectively). Furthermore, there was no significant difference between the groups in the rate of need for blood transfusion (1.3%, 5.4%, 4%, and 4%, respectively; p = 0.6). Limitations: The most important limitation of the study is a relatively small number of participants. Conclusion: In conclusion, our findings suggest that carbetocin may be more successful than oxytocin and oxytocin plus tranexamic acid regimens in terms of postpartum hemoglobin reduction, and there is no difference in terms of the need for blood transfusion when it is used for postpartum hemorrhage prophylaxis after vaginal delivery. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the efficacy of carbetocin for the prevention of postpartum hemorrhage (PPH) and related events after vaginal or cesarean delivery.Methods: Medline, Scopus, Embase, and the Cochrane Library were searched in February 2018 using combinations of the relevant MeSH terms, keywords. Randomized studies, comparing carbetocin to any other uterotonic agent, in the management of cesarean and vaginal deliveries, were conducted. Two reviewers independently extracted the data. A random-effects meta-analysis was used for quantitative synthesis. Also, Bayesian random-effect metaregression was used to estimate the posterior probabilities (PP) for benefits of carbetocin use.Results: After the full-text review, 30 trials were included in the meta-analysis. Compared to oxytocin, carbetocin was associated with a reduced need for additional uterotonic use in women undergoing cesarean delivery (RR 0.43, 95% CI 0.30-0.59, I2 = 71%, 3216 women, PP > 99.9%). Women at high risk of PPH delivering vaginally also had a reduced need for additional uterotonic use with carbetocin compared to oxytocin (RR 0.56, 95% CI 0.34-0.94, I2 = 38%, 789 women, PP = 81.2%). The risk of postpartum blood transfusion (RR 0.57, 95% CI 0.33-0.96, I2 = 0%, 1991 women, PP = 97.9%) was also less with carbetocin compared to oxytocin in high-risk women undergoing cesarean delivery. The risk of PPH was similar between carbetocin and other uterotonic agents for both cesarean (RR 0.69, 95% CI 0.45-1.05, I2 = 27%, 2926 women, PP = 96.3%) and vaginal deliveries (RR 0.61, 95% CI 0.32-1.14, I2 = 35%, 1515 women, PP = 88.9%).Conclusions: Carbetocin is effective in reducing the need for additional uterotonic use and postpartum blood transfusion in women at increased risk of PPH undergoing cesarean delivery. There is still a need for high-quality trials on its effectiveness in preventing PPH in high-risk women.PrecisCarbetocin is effective in reducing the need for additional uterotonic use and postpartum blood transfusion in high-risk women undergoing Cesarean delivery. [ABSTRACT FROM AUTHOR]