title: Carbetocin versus syntometrine in prevention of post-partum hemorrhage following vaginal delivery.
abstract: OBJECTIVE
  To compare the efficacy of a single dose of 100 microg intramuscular carbetocin to a single dose of intramuscular syntometrine (0.5 mg ergometrine and 5IU oxytocin), in preventing post-partum hemorrhage (PPH) in high risk patients following vaginal delivery.
  
  
  METHODS
  A prospective, randomized controlled study was conducted in a tertiary hospital where 120 pregnant women with risk factors for PPH who delivered vaginally were randomized into two groups: the study group where 100 microg intramuscular carbetocin was administered and the control group, who received intramuscular syntometrine. Outcome measures compared included changes in vital signs, amount of intrapartum blood loss, uterine fundal position, addition of another oxytocic agent, side-effects of the drugs, amount of lochia and hemoglobin drop after 24 hours post-partum. Incidence of PPH or other adverse events were also compared.
  
  
  RESULTS
  There were no significant differences in terms of requirement for additional oxytocic agents, time interval to well contracted uterus, blood transfusion requirements, adverse effects or complications. There was a significantly lower mean estimated blood loss in the carbetocin group compared to the syntometrine group (244 +/- 114 mL vs 343 +/- 143 mL, 95% CI 52-146 mL). There was also a significantly reduced drop in hemoglobin in the carbetocin group compared to the syntometrine group (0.3 +/- 0.2 g/dL vs 0.4 +/- 0.2 g/dL, 95% CI 0.1-0.2 g/dL).
  
  
  CONCLUSIONS
  Intramuscular carbetocin may be more effective than intramuscular syntometrine in reducing post-partum blood loss and the drop in hemoglobin level.
authors.affiliation: Department of Obstetrics and Gynaecology, National University of Malaysia, Malaysia. nirmala_k@hotmail.com
authors.forename: Kampan
authors.initials: K
authors.lastname: Nirmala
authors.forename: Ani Amelia
authors.initials: AA
authors.lastname: Zainuddin
authors.forename: Nur Azurah Abdul
authors.initials: NA
authors.lastname: Ghani
authors.forename: Syed
authors.initials: S
authors.lastname: Zulkifli
authors.forename: Mohd Abdul
authors.initials: MA
authors.lastname: Jamil
mesh_terms: D004874:Ergonovine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D010120:Oxytocics; C038346:syntometrine; D010121:Oxytocin; C020731:carbetocin; D004874:Ergonovine