Carbetocin Versus Buccal Misoprostol Plus IV Tranexamic Acid for Prevention of Postpartum Hemorrhage at Cesarean Section
Status:
Completed
Trial end date:
2020-08-01
Target enrollment:
Participant gender:
Summary
The Millennium Development Goal of reducing the maternal mortality ratio by 75 % by 2015 will
remain beyond our reach unless we prioritize the prevention and treatment of postpartum
hemorrhage(PPH) in low-resource countries. Consequently, the administration of uterotonic
drugs during cesarean section (CS) and in the third stage of labor for vaginal delivery has
become essential to diminish the risk of PPH and improve maternal safety.
Oxytocin is regarded as the gold standard uterotonic agent but only has a half-life of 4-10
min; therefore, at cesarean section oxytocin must be administered as a continuous intravenous
infusion to attain sustained uterotonic activity throughout the surgical procedure and
immediate postpartum period.
Misoprostol is a prostaglandin E1 analog proven in several randomized controlled trials to be
effective in preventing PPH because of its strong uterotonic effects. In addition,
misoprostol is inexpensive, stable at room temperature, and easy to administer.
Misoprostol has been broadly studied in the prevention and treatment of PPH after vaginal
delivery; however, its use in conjunction with CS has not been investigated as much.
The buccal route is recognized as having the greatest benefit due to its rapid uptake,
long-acting effect, and greatest bioavailability compared with other routes of misoprostol
administration.
Carbetocin is a long-acting synthetic analog of oxytocin that can be administered as a
single-dose injection; intravenously administered carbetocin has a half-life of approximately
40 min.
A single intravenous bolus of carbetocin produces a tetanic uterine contraction within 2 min
and persists for an average of 60 min following injection.
The aim of this study was to compare the effectiveness of combined buccal misoprostol and IV
tranexamic acid (TA)with intravenous carbetocin for prevention of PPH in patients with risk
factors during cesarean section.