title: Randomized controlled trial comparing carbetocin, misoprostol, and oxytocin for the prevention of postpartum hemorrhage following an elective cesarean delivery.
abstract: OBJECTIVE
  To compare the effectiveness and safety of carbetocin, misoprostol, and oxytocin for the prevention of postpartum hemorrhage following cesarean deliveries.
  
  
  METHODS
  A double-blind randomized controlled trial enrolled patients with a singleton pregnancy scheduled for an elective cesarean delivery at a maternity hospital in Cairo, Egypt, between October 1, 2012 and June 30, 2013. Participants were randomized using a computer-generated sequence to receive treatment with carbetocin, misoprostol, or oxytocin. The primary outcome was the occurrence of uterine atony necessitating additional uterotonics. Per-protocol analyses were performed. Patients, investigators, and data analysts were masked to treatment assignments.
  
  
  RESULTS
  The present study enrolled 263 patients; data were analyzed from 88 patients treated with carbetocin, 89 treated with misoprostol, and 86 women treated with oxytocin. Further uterotonics were needed for the treatment of 5 (6%) patients who were treated with carbetocin, 20 (22%) patients treated with misoprostol, and 11 (13%) patients treated with oxytocin. In the prevention of uterine atony, carbetocin was comparable with oxytocin (RR 0.41, 95%CI 0.14-1.25) and superior to misoprostol (RR 0.21, 95%CI 0.07-0.58).
  
  
  CONCLUSIONS
  Additional uterotonics were needed less frequently by patients treated with carbetocin. Carbetocin was comparable to oxytocin and superior to misoprostol in the prevention of uterine atony following an elective cesarean delivery. ClinicalTrials.gov: NCT02053922.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Abbasia, Cairo, Egypt.
authors.forename: Ahmed E H
authors.initials: AE
authors.lastname: Elbohoty
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Abbasia, Cairo, Egypt.
authors.forename: Walid E
authors.initials: WE
authors.lastname: Mohammed
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Abbasia, Cairo, Egypt. Electronic address: drmsweed@med.asu.edu.eg.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Sweed
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Abbasia, Cairo, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Bahaa Eldin
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Abbasia, Cairo, Egypt.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Nabhan
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Abbasia, Cairo, Egypt.
authors.forename: Karim H I
authors.initials: KH
authors.lastname: Abd-El-Maeboud
mesh_terms: D000328:Adult; D002585:Cesarean Section; D004534:Egypt; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage / Q000627:therapeutic use; D010120:Oxytocics / Q000008:administration & dosage / Q000627:therapeutic use*; D010121:Oxytocin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D018743:Perinatal Care; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D016896:Treatment Outcome
chemical_list: D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin; C020731:carbetocin
keywords: Atony; Carbetocin; Cesarean delivery; Misoprostol; Oxytocin; Postpartum hemorrhage