Comparison of the Efficacy of Carbetocin and Oxytocın to Prevent Postpartum Hemorrhage After Cesarean Delivery

Yıl 2020, Cilt: 22 Sayı: 3, 386 - 392, 31.12.2020

Ramazan Bülbül Mehmet Murat Işıkalan Ali Acar

https://doi.org/10.24938/kutfd.766871

Öz

Objective: This study aimed to compare the effect of postpartum carbetocin and oxytocin administration on the estimated amount of bleeding, need for additional oxytocin and alteration of hemoglobin levels in patients undergoing elective cesarean section under regional anesthesia.

Material and Methods: This study was performed retrospectively between January 2017 and September 2019 in women who delivered by elective cesarean section under regional anesthesia and were administered carbetocin (study group) or oxytocin (control group). Singleton pregnant women at low risk for postpartum hemorrhage who underwent elective cesarean section under regional anesthesia between 37 and 40 weeks of gestation were included in the study. Patients were compared in terms of the estimated amount of bleeding before and after delivery, the need for additional oxytocin and hemoglobin values.

Results: Perioperative estimated bleeding amounts of carbetocin group and oxytocin group were 600±328 cc and 541±215 cc, respectively (p=0.713). There was no significant difference in hemoglobin decrease and additional uterotonic requirement in both groups (p=0.65, p=0.69, respectively).

Conclusion: It seems appropriate to use oxytocin as the first choice in patients with low risk of bleeding, because of its lower cost and similar efficacy in studies.

Anahtar Kelimeler

Cesarean section, carbetocin, oxytocin, postpartum hemorrhage

SEZARYEN DOĞUM SONRASINDA POSTPARTUM HEMORAJİNİN ÖNLENMESİNDE UYGULANAN KARBETOSİN VE OKSİTOSİNİN ETKİNLİĞİNİN KARŞILAŞTIRILMASI

Öz

Amaç: Bu çalışmanın amacı rejyonal anestezi altında elektif sezaryen ile doğum yapan hastalarda postpartum karbetosin ile oksitosin uygulamasının tahmini kanama miktarı, ek oksitosin ihtiyacı ve hemoglobin değerleri üzerindeki etkisini karşılaştırmaktır.

Gereç ve Yöntemler: Çalışmamız 2017 Ocak ile 2019 Eylül tarihleri arasında hastanemizde rejyonal anestezi altında elektif sezaryen operasyonu ile doğum yapan ve karbetosin uygulanan hasta grubu (vaka grubu) ile, oksitosin uygulanan (kontrol grubu) kadınlar arasında retrospektif olarak yapıldı. Çalışmaya 37 ile 40 gebelik haftaları arasındaki rejyonal anestezi altında elektif sezaryen doğum gerçekleştirilen, postpartum kanama açısından düşük riskli tekil gebe kadınlar dahil edildi. Hastalar, doğum öncesi ve sonrası tahmini kanama miktarı, ek oksitosin ihtiyacı ve hemoglobin değerleri bakımından karşılaştırıldı.

Bulgular: Karbetosin ve oksitosin gruplarının tahmini perioperatif kanama miktarları sırasıyla 600±328 cc ve 541±215 cc olarak saptandı (p=0.713). Her iki grupta hemoglobin düşüşü ve ek uterotonik ihtiyacı bakımından da anlamlı fark saptanmadı (Sırasıyla; p=0.65, p=0.69).

Sonuç: Kanama riski yüksek olmayan hasta grubunda, daha düşük maliyetli olması ve çalışmalarda benzer etkinlik göstermesi nedeniyle oksitosinin hala ilk seçenek olarak kullanılması uygun gözükmektedir.

Anahtar Kelimeler

karbetosin, oksitosin, postpartum kanama, sezaryen

Kaynakça

• 1. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367(9516):1066-74.
• 2. Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol. 2008;22(6):999-1012.
• 3. Thomas J, Paranjothy S. RCOG Clinical Effectiveness Support Unit. The National Sentinel Caesarean Section Audit Report. London. UK: RCOG Press, 2001.
• 4. Santas G, Santas F. Trends of caesarean section rates in Turkey. J Obstet Gynaecol. 2018;38(5):658-62. Doi:10.1080/01443615.2017.1400525.
• 5. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. 2017;130(4):e168-e86.
• 6. Jin B, Du Y, Zhang F, Zhang K, Wang L, Cui L. Carbetocin for the prevention of postpartum hemorrhage: a systematic review and meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med. 2016;29(3):400-7. Doi:10.3109/14767058.2014.1002394.
• 7. Begley CM, Gyte GM, Devane D, McGuire W, Weeks A. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev. 2015(3):CD007412. Doi:10.1002/14651858.CD007412.pub4.
• 8. Begley CM, Gyte GM, Devane D, McGuire W, Weeks A, Biesty LM. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev. 2019(2):CD007412. Doi:10.1002/14651858.CD007412.pub5.
• 9. Kalafat E, Gokce A, O’Brien P, Benlioglu C, Koc A, Karaaslan O et al. Efficacy of carbetocin in the prevention of postpartum hemorrhage: a systematic review and Bayesian meta-analysis of randomized trials. J Matern Fetal Neonatal Med. 2019;1-14: Doi:10.1080/14767058.2019.1664463.
• 10. Chong YS, Su LL, Arulkumaran S. Current strategies for the prevention of postpartum haemorrhage in the third stage of labour. Curr Opin Obstet Gynecol. 2004;16(2):143-50. Doi:10.1097/00001703-200404000-00008.
• 11. Dansereau J, Joshi AK, Helewa ME, Doran TA, Lange IR, Luther ER et al Double-blind comparison of carbetocin versus oxytocin in prevention of uterine atony after cesarean section. Am J Obstet Gynecol. 1999;180(3 Pt 1):670-6. Doi:10.1016/s0002-9378(99)70271-1.
• 12. Stafford I, Dildy GA, Clark SL, Belfort MA. Visually estimated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol. 2008;199(5):519.e1-7.
• 13. Amsalem H, Aldrich CJ, Oskamp M, Windrim R, Farine D. Postpartum uterine response to oxytocin and carbetocin. J Reprod Med. 2014;59(3-4):167-73.
• 14. Gizzo S, Patrelli TS, Gangi SD, Carrozzini M, Saccardi C, Zambon A et al. Which uterotonic is better to prevent the postpartum hemorrhage? Latest news in terms of clinical efficacy, side effects, and contraindications: a systematic review. Reprod Sci. 2013;20(9):1011-9.
• 15. Manrique Muñoz S, Munar Bauzà F, Francés González S, Suescun López MC, Montferrer Estruch N, Fernández López de Hierro C. Actualización en el uso de uterotónicos. Rev Esp Anestesiol Reanim. 2012;59(2):91-7. Spanish. Doi:10.1016/j.redar.2012.02.019.
• 16. van der Nelson HA, Draycott T, Siassakos D, Yau CWH, Hatswell AJ. Carbetocin versus oxytocin for prevention of post-partum haemorrhage at caesarean section in the United Kingdom: An economic impact analysis. Eur J Obstet Gynecol Reprod Biol. 2017;210:286-91.
• 17. Dansereau J, Joshi AK, Helewa ME, Doran TA, Lange IR, Luther ER et al. Double-blind comparison of carbetocin versus oxytocin in prevention of uterine atony after cesarean section. Am J Obstet Gynecol. 1999;180(3 Pt 1):670-6.
• 18. Attilakos G, Psaroudakis D, Ash J, Buchanan R, Winter C, Donald F et al. Carbetocin versus oxytocin for the prevention of postpartum haemorrhage following caesarean section: the results of a double-blind randomised trial. Bjog. 2010;117(8):929-36.
• 19. Boucher M, Horbay GL, Griffin P, Deschamps Y, Desjardins C, Schulz M et al. Double-blind, randomized comparison of the effect of carbetocin and oxytocin on intraoperative blood loss and uterine tone of patients undergoing cesarean section. J Perinatol. 1998;18(3):202-7.
• 20. El Behery MM, El Sayed GA, El Hameed AA, Soliman BS, Abdelsalam WA, Bahaa A. Carbetocin versus oxytocin for prevention of postpartum hemorrhage in obese nulliparous women undergoing emergency cesarean delivery. J Matern Fetal Neonatal Med. 2016;29(8):1257-60.
• 21. Borruto F, Treisser A, Comparetto C. Utilization of carbetocin for prevention of postpartum hemorrhage after cesarean section: a randomized clinical trial. Arch Gynecol Obstet. 2009;280(5):707-12.
• 22. Whigham CA, Gorelik A, Loughnan TE, Trivedi A. Carbetocin versus oxytocin to reduce additional uterotonic use at non-elective caesarean section: a double-blind, randomised trial. J Matern Fetal Neonatal Med. 2016;29(23):3866-9.
• 23. 23. Voon HY, Suharjono HN, Shafie AA, Bujang MA. Carbetocin versus oxytocin for the prevention of postpartum hemorrhage: A meta-analysis of randomized controlled trials in cesarean deliveries. Taiwan J Obstet Gynecol. 2018;57(3):332-9. doi:10.1016/j.tjog.2018.04.002.
• 24. Tita AT, Szychowski JM, Rouse DJ, Bean CM, Chapman V, Nothern A et al. Higher-dose oxytocin and hemorrhage after vaginal delivery: a randomized controlled trial. Obstet Gynecol. 2012;119(2 Pt 1):293-300.