Carbetocin Versus Oxytocin and Ergometrine for the Prevention of Postpartum Hemorrhage
Status:
Completed
Trial end date:
2020-08-01
Target enrollment:
Participant gender:
Summary
The cesarean section is a bloody operation, about 750 to 1000 ml are lost at most operations
and over 1000 ml of blood have lost to bring them into the definition of a postpartum
hemorrhage (PPH). In developing countries, PPH is the main cause of maternal deaths. Uterine
atony is the most common cause of immediate heavy PPH.Multiple pregnancy ones of a common
factor for uterine atony. The administration of oxytocic's after the delivery of the neonate
reduces the likelihood of PPH and 5 IU oxytocin by slow intravenous injection is currently
recommended for all cesarean sections. However, the use of additional oxytocic medication is
common, to arrest bleeding, or prophylactically if there are risk factors for PPH .
Carbetocin is a synthetic analog of human oxytocin with structural modifications that
increase its half-life, thereby prolonging its pharmacological effects. Carbetocin has been
approved in 23 countries for prevention of uterine atony and excessive bleeding following
cesarean delivery in spinal or epidural anesthesia. Oxytocin is a peptide of nine amino acids
(Nona peptide). The structure of oxytocin is very similar to that of arginine vasopressin,
whose sequence differs from oxytocin by 2 amino acids. The best-known mechanism for oxytocin
to exert its stimulatory effect on myometrial contractility is by increasing the
intracellular concentration of calcium. Owing to its short plasma half-life (mean 3 min), a
continuous intravenous infusion is required to maintain the uterus in a contracted state. The
usual dose is 20 IU in 500 ml of crystalloid solution, with the dosage rate adjusted
according to response. Ergometrine is a selective and moderately potent tryptaminergic
receptor antagonist in various smooth muscles, being only a partially agonistic or
antagonistic at tryptaminergic receptors in the central nervous system. In blood vessels, the
alkaloid is only weakly antagonistic of dopaminergic receptors and partially agonistic of
α-adrenergic receptors. oxytocin (19%). Blood loss>500 ml was only observed in women who
received oxytocin. The aim of the investigator's study was to compare the effect of
carbetocin vs. oxytocin and ergometrine for prevention of PPH during cesarean section in
women with multiple pregnancies.