Carbetocin versus syntometrine for prevention of postpartum hemorrhage after cesarean section.
OBJECTIVE
To compare effectiveness and tolerability of carbetocin versus syntometrine in prevention of postpartum hemorrhage (PPH) after cesarean section (CS).


METHODS
A double-blind randomized study conducted on 300 pregnant subjected randomly either to single 100 μg IV dose of carbetocin (150 women) or combination of 5 IU oxytocin and 0.2 mg ergometrine (150 women) after fetal extraction and before placental removal. Primary outcome parameter was the occurrence of PPH. Other parameters were hemoglobin and hematocrit changes, the need of additional oxytocic, hemodynamic changes and occurrence of side effects.


RESULTS
There was no significant difference between the two study groups regarding hemoglobin and hematocrit at start of CS and after 2 days of surgery and mean blood loss during the operation (p > 0.05). There was a highly significant difference between the two study groups regarding incidence of primary PPH (2.7% versus10%) and the need of additional oxytocic (3.3% versus17.3%). Women in oxytocin group showed a statistically significant lower systolic and diastolic blood pressure at 1, 5 and 30 min than women in carbetocin group. Women in carbetocin group experienced more metallic taste, flushing, headache, dizziness, dyspnea and itching, while women in oxytocin methergine group experienced more palpitations.


CONCLUSIONS
Carbetocin is a reasonable effective alternative to syntometrine in prevention of PPH after cesarean delivery.
a Obstetrics and Gynecology Department, Kasr Aini Hospital, Cairo University , Cairo , Egypt.
Ahmed
A
Mohamed Maged
b Anaesthesia and Pain Department, National Cancer Institute, Cairo University , Cairo , Egypt , and.
Ahmed Shaker
AS
Ragab
a Obstetrics and Gynecology Department, Kasr Aini Hospital, Cairo University , Cairo , Egypt.
Noura
N
Elnassery
a Obstetrics and Gynecology Department, Kasr Aini Hospital, Cairo University , Cairo , Egypt.
Walaa
W
Ai Mostafa
a Obstetrics and Gynecology Department, Kasr Aini Hospital, Cairo University , Cairo , Egypt.
Sherif
S
Dahab
c Obstetrics and Gynecology Department, Beni-Suef Hospital, Beni-Suef University , Cairo , Egypt.
Amal
A
Kotb
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D004311:Double-Blind Method; D004874:Ergonovine / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010120:Oxytocics / Q000009:adverse effects; D010121:Oxytocin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006473:Postpartum Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D011247:Pregnancy; D011644:Puerperal Disorders / Q000139:chemically induced; D055815:Young Adult
D010120:Oxytocics; C038346:syntometrine; D010121:Oxytocin; C020731:carbetocin; D004874:Ergonovine
Carbetocin; cesarean section; postpartum hemorrhage; syntometrine