RESERVES FOR REDUCING BLOOD LOSS DURING ABDOMINAL DELIVERY: RESULTS OF A RANDOMIZED TRIAL


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Abstract

The investigations were conducted at the clinical bases: Department of Obstetrics and Gynecology with Course of Perinatology Peoples' Friendship University of Russia; Department of Obstetrics and Gynecology, Prof. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia; Obstetrics and Gynecology Department One, Rostov State Medical University, Ministry of Health of Russia; Regional Children's Clinical Hospital One, Department of Anesthesiology, Reanimatology, and Transfusiology, Ural State Medical University, Ministry of Health of Russia, Yekaterinburg; Department of Public Health Organization and Informatization and Department for Prevention of Non-Communicable Diseases, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia; Regional Perinatal Center, Healthcare Department of the Tomsk Region; Department of Anesthesiology and Reanimatology, M.F. Vladimirsky Moscow Regional Research Clinical Institute, Obstetrics and Gynecology Department Two, Kazan State Medical University; Objective. To compare the efficiency and safety of the uterotonic drugs oxytocin and carbetocin for the prevention of hypotonic and atonic bleeding in high-risk patients during cesarean section. Subjects and methods. Patients were included and randomized from March to September 2014. Group 1 of 163 patients received carbetocin (pabal) and Group 2 of 180 patients had oxytocin. The inclusion criteria were a uterine scar after cesarean section, multiple pregnancy, placenta previa, a large fetus, cesarean section with conservative myomectomy, placental abruption, and hypotonic bleeding. During cesarean section, a single carbetocin dose (100 μg/ml) was injected immediately after a baby’s removal. Intravenous and intramuscular oxytocin solution 1.0 (5 IU) No. 5 (Gedeon Richter, Hungary) was used as a comparison drug. Results. The performed comparative investigation of the efficacy and safety of pabal (carbetocin) and oxytocin has established that the former has a more marked and longer uterotonic effect than the latter and, accordingly, a higher clinical efficacy in preventing bleeding due to uterine atony. Conclusion. Pabal (carbetocin) is an effective uterotonic agent that significantly reduces the amount of blood loss during cesarean section as compared to oxytocin in the patients with a uterine scar, a large fetus, multiple pregnancy. Additional methods for arresting bleeding are significantly less frequently required. The use of carbetocin promotes a decline in the frequency of hysterectomies due to hypotonic bleeding.

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About the authors

V. E RADZINSKY

Peoples' Friendship University of Russia

Email: radzinsky@mail.ru
Department of obstetrics & gynecology Moscow 111020, Gospitalnaya sq. 2, Russia

T. V GALINA

Peoples' Friendship University of Russia

Email: tatiana.galinal@mail.ru
Department of obstetrics & gynecology Moscow 111020, Gospitalnaya sq. 2, Russia

N. P KIRBASOVA

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia

Email: kirbasova@yandex.ru
Department of Organization and Public Health Moscow 109004, Alexander Solzhenitsyn str. 28, Russia

N. M MARKARYAN

Peoples' Friendship University of Russia

Email: naramm@mail.ru
Department of obstetrics & gynecology Moscow 111020, Gospitalnaya sq. 2, Russia

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