Objectives: Evaluation of the clinical yield of prophylactic carbetocin versus oxytocin single shoot
injection in parturient high-risk for developing postpartum hemorrhage (PPH) undergoing cesarean section (CS).
Patients & Methods: The study included 150 parturient with mean age of 27.6±2.1 years and having at least one
high-risk for development of PPH. Patients were randomly allocated into two equal groups to receive slow intravenous
injection of single dose of carbetocin 100 μg (Group C) or oxytocin 5 IU (Group O) at time of umbilical cord
clamping. Uterine tone was assisted and rated according to the extent of indentation by finger pressure using a 5-point
scale. Obstetric hemorrhage was calculated according to postoperative packed cell volume (PCV) deficit. Rescue
uterotonic was provided in form of slow injection of oxytocin 5 IU diluted to 3 ml with normal saline. The frequency
of rescue uterotonic used since administration of study dose till 24-hrs after surgery was reported. Postoperative
hemoglobin concentration and deficit, amount of intraoperative and postoperative blood loss and need for blood
transfusion were recorded. Results: Both drugs provided successful uterotonic effect; 107 patients (71.3%) had grade-4 uterus and only 3 patients (2%) in group O had grade 0 and one uteri with non-significant difference in favor of
group C. Twenty-six patients (17.3%) required rescue uterotonic; 7 in group C and 19 in group O with significantly
higher frequency of patients required rescue uterotonic in group O. Postoperative PCV and hemoglobin concentration
were significantly lower compared to preoperative estimates in both groups, with significant difference in favor of
group C. Thirty-four patients (22.7%) developed side effects of used medications with non-significant difference in
favor of group C. Conclusion: Single bolus injection of carbetocin reduced the frequency and severity of postpartum
hemorrhage in high risk women assigned for elective cesarean section. It also spares the use of rescue uterotonic and
blood transfusion with minimal drug-related side effects. |
