title: A randomised trial of carbetocin versus syntometrine in the management of the third stage of labour.
abstract: OBJECTIVE
  Syntometrine is an effective uterotonic agent used in preventing primary postpartum haemorrhage but has adverse effects including nausea, vomiting, hypertension and coronary artery spasm. Carbetocin is a newly developed long-acting oxytocin analogue that might be used as an uterotonic agent. We compare the efficacy and safety of intramuscular (IM) carbetocin with IM syntometrine in preventing primary postpartum haemorrhage.
  
  
  METHODS
  Prospective, double-blinded, randomised controlled trial.
  
  
  METHODS
  Delivery suite of a university-based obstetrics unit.
  
  
  METHODS
  Women with singleton pregnancy achieving vaginal delivery after and throughout 34 weeks.
  
  
  METHODS
  Three hundred and twenty-nine eligible women were randomised to receive either a single dose of 100 microgram IM carbetocin or 1 ml IM syntometrine (a mixture of 5 iu oxytocin and 0.5 mg ergometrine) at the end of second stage of labour.
  
  
  METHODS
  Difference in haemoglobin drop measured 2 days after delivery between the two groups.
  
  
  RESULTS
  There was no difference in the drop of haemoglobin concentration within the first 48 hours between the two groups. The incidence of additional oxytocic injections, postpartum haemorrhage (blood loss > or = 500 ml) and retained placenta were also similar. The use of carbetocin was associated with significant lower incidence of nausea (relative risk [RR] 0.18, 95% confidence interval [CI] 0.04-0.78), vomiting (RR 0.1, 95% CI 0.01-0.74), hypertension 30 minutes (0 versus 8 cases, P < 0.01) and 60 minutes (0 versus 6 cases, P < 0.05) after delivery but a higher incidence of maternal tachycardia (RR 1.68, 95% CI 1.03-3.57).
  
  
  CONCLUSIONS
  IM carbetocin is as effective as IM syntometrine in preventing primary postpartum haemorrhage after vaginal delivery. It is less likely to induce hypertension and has a low incidence of adverse effect. It should be considered as a good alternative to conventional uterotonic agents used in managing the third stage of labour.
authors.affiliation: Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR. swleung@cuhk.hk
authors.forename: S W
authors.initials: SW
authors.lastname: Leung
authors.forename: P S
authors.initials: PS
authors.lastname: Ng
authors.forename: W Y
authors.initials: WY
authors.lastname: Wong
authors.forename: T H
authors.initials: TH
authors.lastname: Cheung
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D004874:Ergonovine; D005260:Female; D006801:Humans; D007749:Labor Stage, Third; D010120:Oxytocics; D010121:Oxytocin / Q000031:analogs & derivatives*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D010120:Oxytocics; C038346:syntometrine; D010121:Oxytocin; C020731:carbetocin; D004874:Ergonovine