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Third Stage Of Labor
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Alyssa R. Hersh, Jorge E. Tolosa
Carbetocin is a synthetic analogue of oxytocin; 100 μg IV has been shown to reduce the need for therapeutic uterotonics compared to oxytocin for those women who underwent cesareansection [10]. Compared with Syntometrine (oxytocin plus ergometrine), carbetocin is associated with less blood loss and fewer side effects when used prophylactically following vaginal delivery; however, the risk of PPH is not decreased [10, 11]. An international randomized, controlled noninferiority trial, which enrolled over 29,000 women expected to give birth vaginally, found that heat-stable carbetocin was noninferior to oxytocin for the use of additional uterotonics or blood loss of greater than 500 mL; however, noninferiority was not demonstrated with blood loss greater than 1000 mL [12]. There was no difference in adverse events. As carbetocin is similar to oxytocin in outcomes but not widely available, the decision to use it compared to oxytocin should be based on local circumstances.
Pregnancy
Published in Sarah Armstrong, Barry Clifton, Lionel Davis, Primary FRCA in a Box, 2019
Sarah Armstrong, Barry Clifton, Lionel Davis
Drugs to consider Oxytocin/CarbetocinErgometrineCarboprostAntifibrinolytics
Post-Partum Haemorrhage
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
First step: Administration of a tocotonic agent immediately after delivery of the fetus. The pharmacological agents that can be used are Intramuscular injection of 10 units of oxytocin (slow intravenous 5 units is given during caesarean section).Carbetocin 100 µg intramuscular injection has been recommended recently by WHO. Carbetocin does not require a cold chain and has a longer duration of action. This makes it more suitable for countries and sets up where the cold chains cannot be ensured. At present, it is expensive and not easily affordable in peripheral centres and low-resource countries.Intravenous infusion of oxytocin drip (10 units in a 500 mL bottle of saline or ringer lactate at 30 drops per minute).Administration of misoprostol, either sublingual or oral or per rectum. Misoprostol of 600–800 µg can be administered.Hundred and fifty micrograms of prostaglandin F2α, administered intramuscularly within 1 minute of delivery of the fetus.Intravenous methyl ergometrine 0.25 mg. The administration should be timed accurately at the delivery of the anterior shoulder and followed by slow delivery of the baby to give enough time for the separated placenta to deliver out behind the fetus. Even a slight delay in administration can cause retention of the placenta due to hourglass constriction of the uterus. This drug can cause a rise in blood pressure and worsen vasospasms, so it should be used with caution.
Cost-effectiveness analysis of carbetocin versus oxytocin for the prevention of postpartum hemorrhage following vaginal birth in the United Kingdom
Published in Journal of Medical Economics, 2022
Suzette Matthijsse, Fredrik L. Andersson, Michael Gargano, Yum L. Yip Sonderegger
PPH is the most commonly occurring form of obstetric hemorrhage and has been increasing in prevalence over time in many developed and developing countries, driven by an increase in uterine atony, which causes almost 80% of PPH events10. Uterotonics are the standard of care for the prevention of PPH events following vaginal birth and oxytocin is the most widely used among them. Carbetocin is a synthetic oxytocin analogue; when compared with oxytocin for PPH prophylaxis following vaginal birth, carbetocin was found to cost-effective from a UK NHS perspective, leading to savings of £55 and 0.0342 less PPH events per woman in the deterministic base case. In addition, per an exploratory analysis, it led to a marginal increase of 0.0001 QALYs per woman. Carbetocin may provide a less costly alternative while preventing more PPH events following vaginal birth.
Carbetocin versus oxytocin for prevention of postpartum hemorrhage in hypertensive women undergoing elective cesarean section
Published in Hypertension in Pregnancy, 2020
Zakia M. Ibrahim, Waleed A. Sayed Ahmed, Eman M. Abd El-Hamid, Omima T. Taha, Amira M. Elbahie
Hemorrhage is a leading contributor to maternal mortality, especially in developing countries, accounting for more than 30% of direct causes (1,2). Other risk factors include a cesarean section (CS) as well as hypertensive disorders (3). The most commonly used uterotonic agent is oxytocin. It is characterized by a short half-life of only 4–10 min, which mandates continuous intravenous infusion to guarantee sustained uterotonic activity (4). The recently introduced analogue to oxytocin, carbetocin, is a long-acting synthetic octapeptide (5) that binds to oxytocin receptors on the smooth muscles of the uterus, resulting in more robust and regular uterine contractions (6). Accordingly, it is more advantageous over oxytocin in the management of the third stage of labor (7), especially with a similar side effect profile (8).