title: Carbetocin compared to oxytocin in emergency cesarean section: a randomized trial.
abstract: OBJECTIVE
  To evaluate the uterotonic effect of carbetocin compared with oxytocin in emergency cesarean delivery.
  
  
  METHODS
  Participants were randomized to intravenous bolus injection of 100mcg carbetocin or 10IU oxytocin after cesarean delivery of the baby. The primary outcome is any additional uterotonic which may be administered by the blinded provider for perceived inadequate uterine tone with or without hemorrhage in the first 24hours after delivery. Secondary outcomes include operating time, perioperative blood loss, change in hemoglobin and hematocrit levels, blood transfusion and reoperation for postpartum hemorrhage.
  
  
  RESULTS
  Additional uterotonic rates were 107/276 (38.8%) vs. 155/271 (57.2%) [RR 0.68 95% CI 0.57-0.81 p<0.001; NNTb 6 95% CI 3.8-9.8], mean operating time 45.9±16.0 vs. 44.5±13.1minutes p=0.26, mean blood loss 458±258 vs. 446±281ml p=0.6, severe postpartum hemorrhage (≥1000ml) rates 15/276 (5.4%) vs. 10/271 (3.7%) p=0.33 and blood transfusion rates 6/276 (2.2%) vs. 10/271 (3.7%); p=0.30 for carbetocin and oxytocin arms respectively. There was only one case of re-operation (oxytocin arm). In the cases that needed additional uterotonic 98% (257/262) was started intraoperatively and in 89% (234/262) the only additional uterotonic administered was an oxytocin infusion over 6hours.
  
  
  CONCLUSIONS
  Fewer women in the carbetocin arm needed additional uterotonics but perioperative blood loss, severe postpartum hemorrhage, blood transfusion and operating time were not different.
authors.affiliation: Department of Obstetrics and Gynaecology, University Malaya, 59100 Kuala Lumpur, Malaysia. Electronic address: nuguelis@ummc.edu.my.
authors.forename: Nuguelis
authors.initials: N
authors.lastname: Razali
authors.affiliation: Department of Obstetrics and Gynaecology, University Malaya, 59100 Kuala Lumpur, Malaysia.
authors.forename: Ida Lilywaty
authors.initials: IL
authors.lastname: Md Latar
authors.affiliation: Department of Anaesthesiology, University Malaya, 59100 Kuala Lumpur, Malaysia.
authors.forename: Yoo Kuen
authors.initials: YK
authors.lastname: Chan
authors.affiliation: Department of Obstetrics and Gynaecology, University Malaya, 59100 Kuala Lumpur, Malaysia.
authors.forename: Siti Zawiah
authors.initials: SZ
authors.lastname: Omar
authors.affiliation: Department of Obstetrics and Gynaecology, University Malaya, 59100 Kuala Lumpur, Malaysia.
authors.forename: Peng Chiong
authors.initials: PC
authors.lastname: Tan
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000379:methods*; D004311:Double-Blind Method; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D010120:Oxytocics / Q000627:therapeutic use*; D010121:Oxytocin / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D011247:Pregnancy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010120:Oxytocics; D010121:Oxytocin; C020731:carbetocin
keywords: Blood transfusion; Carbetocin; Oxytocin; Postpartum hemorrhage