Prevention of postpartum haemorrhage in patients with severe preeclampsia using carbetocin versus misoprostol

Background. Haemorrhage is a leading cause of maternal death worldwide, accounting for over 30% of maternal deaths in Africa and Asia. Postpartum bleeding was also 1.6 times higher in women with preeclampsia than in normotensive women. Objective. We aimed to prevent postpartum haemorrhage in patients with severe preeclampsia by using either carbetocin or misoprostol. The primary outcome was postpartum haemorrhage (blood loss of ≥ 500 ml) while our Secondary outcomes included use of other uterotonics, blood transfusion, maternal complications and maternal death. Methods. This prospective, randomised study was done in Department of Obstetrics and Gynecology, Benha university hospital, Benha University. 60 pregnant women candidate for vaginal delivery with severe preeclampsia received either carbetocin or misoprostol after delivery of the baby. Results. Carbetocin was superior to misoprostol with lower duration of third stage of labour (P=0.036), lower amount of blood loss (P=0.017) and lower incidence of PPH (P=0.03). There was no significant difference in the pre-delivery and the post-delivery haemoglobin concentration between the two groups with P=0.061. The need of additional uterotonics and blood transfusion was higher with misoprostol as compared to cabetocin with P=0.037 and 0.009, respectively. As regards side effects, misoprostol was associated with shivering and pyrexia in significantly high number of patients as compared to cabetocin while nausea, vomiting and headache were more associated with cabetocin. Conclusions. Carbetocin was more effective than misoprostol when used in women with severe preeclampsia to prevent postpartum bleeding.

carbetocin, misoprostol, pre-eclampsia, postpartum haemorrhage