title: Carbetocin versus oxytocin for the prevention of postpartum haemorrhage following caesarean section: the results of a double-blind randomised trial.
abstract: OBJECTIVE
  To compare the effectiveness of carbetocin and oxytocin when they are administered after caesarean section for prevention of postpartum haemorrhage (PPH).
  
  
  METHODS
  Double-blind randomised single centre study (1:1 ratio).
  
  
  METHODS
  Teaching hospital in Bristol, UK with 6000 deliveries per annum.
  
  
  METHODS
  Women at term undergoing elective or emergency caesarean section under regional anaesthesia, excluding women with placenta praevia, multiple gestation and placental abruption.
  
  
  METHODS
  Women were randomised to receive either carbetocin 100 microg or oxytocin 5 IU intravenously after the delivery of the baby. Perioperative care was otherwise normal and use of additional oxytocics was at the discretion of the operating obstetrician. Analysis was by intention to treat.
  
  
  METHODS
  The proportion of women in each arm of the trial that needed additional pharmacological oxytocic interventions.
  
  
  RESULTS
  Significantly more women needed additional oxytocics in the oxytocin group (45.5% versus 33.5%, Relative risk 0.74, 95% CI 0.57-0.95). The majority of women had oxytocin infusions. There were no significant differences in the secondary outcomes, including major PPH, blood transfusions and fall in haemoglobin.
  
  
  CONCLUSIONS
  Carbetocin is associated with a reduced use of additional oxytocics. It is unclear whether this may reduce rates of PPH and blood transfusions.
authors.affiliation: Directorate of Women's and Children's Health, Southmead Hospital, North Bristol NHS Trust, Bristol, UK. georgeattilakos@doctors.org.uk
authors.forename: G
authors.initials: G
authors.lastname: Attilakos
authors.forename: D
authors.initials: D
authors.lastname: Psaroudakis
authors.forename: J
authors.initials: J
authors.lastname: Ash
authors.forename: R
authors.initials: R
authors.lastname: Buchanan
authors.forename: C
authors.initials: C
authors.lastname: Winter
authors.forename: F
authors.initials: F
authors.lastname: Donald
authors.forename: L P
authors.initials: LP
authors.lastname: Hunt
authors.forename: T
authors.initials: T
authors.lastname: Draycott
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D010298:Parity; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010120:Oxytocics; D010121:Oxytocin; C020731:carbetocin