Experience with carbetocin for preventing hypotonic hemorrhage

Objective. To evaluate the efficacy of carbetocin for the prevention of postpartum bleeding (PPB) during spontaneous labor. Subjects and methods. In July 2013 to September 2014, the obstetric hospitals of the Mother and Baby Perinatal Medical Center administered carbetocin to 229 high-risk parturients for the prevention of PPB during spontaneous labor. A comparison group included 200 patients who had taken oxytocin for this purpose. The indication for the use of the above drugs was the presence of at least one risk factor for hemorrhage. The parturients in both groups were matched for age, parity, and weight and height characteristics. All the pregnancies were singleton; the gestation age was more than 36 weeks. Results. The proportion of patients with physiological blood loss was higher in Group 1 [n = 215 (93.3%)] than in Group 2 [n = 181 (90.5%)]; the average amount of blood lost in these patients was 344.6±79.5 and 363.6±72.3 ml, respectively. In 12 (5.2%) patients in the study group and in 16 (8.0%) in the control group, the volume of blood loss was more than 0.5% of body weight (not more than 1 liter), averaging 678.8±106.5 and 695.3±127.5 ml in Groups 1 and 2, respectively. Early PPB occurred an average of 25±13 minutes after placental removal and required external uterine massage and administration of an additional oxytocin dose during 2-3 hours in all the patients with hemorrhage, as well as manual uterine examination and external and internal uterine compression with a fist in 12 (5.2%) patients in the study group and in 16 (8.0%) parturients in Group 2. A blood loss of more than 1 liter occurred in 2 (0.9%)parturients in Group 1 (a blood loss of 1000 and 1200 ml) in 3 (1.5%) in Group 2 (a blood loss of 1100 to 1500 ml). Analysis of adverse reactions to carbetocin and oxytocin revealed that the proportion of the above complications was higher in the parturients receiving oxytocin [n = 44 (22.0%)]. The adverse reactions of carbetocin occurred in 40 (17.0%) patients. Conclusion. The investigation has shown the high efficacy of both carbetocin and oxytocin for the prevention of obstetric hemorrhage in high-risk patients. The distinctive feature of carbetocin is the rapidity and prolongation of its action after single administration.

obstetric hemorrhage, hemorrhage prevention, carbetocin, pabal, oxytocin