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Carbetocin versus oxytocin on the need for second-line uterotonics in parturients requiring cesarean delivery for labor dystocia
Abstract Number: F-13
Abstract Type: Original Research
Background: Oxytocin is the most often used uterotonic agent for active management of 3rd stage of labor. However, in 2009, the Society of Obstetricians and Gynaecologists of Canada (SOGC) recommended carbetocin as the first-line agent for elective cesarean delivery (CD) for the prevention of postpartum hemorrhage (PPH) . We hypothesized that carbetocin would be superior to oxytocin in preventing the need for second-line uterotonics in parturients who underwent CD for labor dystocia and were previously exposed to intrapartum oxytocin.
Methods: We conducted a retrospective study. Inclusion criteria were parturients undergoing CD for labor dystocia with BMI ≤ 40 kg/m2 and ASA PS 2. Medical records from 2004-2009 were reviewed and 894 parturients were included. Parturients who received variable doses of IV oxytocin (20-60 IU) were compared with parturients who received IV carbetocin (100 mcg) both during CD. The primary outcome was the need for additional uterotonics during CD. Secondary outcomes included estimated blood loss, perioperative hemoglobin variations, durations of intrapartum oxytocin exposure and time of discontinuation of oxytocin before CD.
Results: 478 and 416 parturients were included in the oxytocin and the carbetocin groups, respectively. No difference was found between the 2 groups regarding demographics, obstetric history and risk factors for uterine atony. There was no difference in the perioperative use of second-line uterotonics between oxytocin and carbetocin (8.4% vs 8.2%; P > 0.99). The mean (± SD) estimated blood loss was 857 ± 222 and 899 ± 211 mL in the carbetocin and oxytocin groups, respectively (P = 0.001), but the difference between the post and pre-op hemoglobin levels in the 2 groups were not significant (24 ± 10 vs 26 ± 10 g/L; P = 0.08). Using a logistic regression analysis, duration of intrapartum oxytocin exposure >10 hours presented a higher risk to receive a second-line uterotonic compared to an exposure of < 3 h (OR 4.64, 95% CI 1.43-15.12; P = 0.01). The presence of chorioamnionitis was also a risk factor for second-line uterotonics use (OR 1.65, 95% CI 1.02-2.68; P = 0.04). A 90-min or greater interval between oxytocin discontinuation and delivery compared to < 30 min was not associated with a lower risk of second-line uterotonic use in women who received intrapartum oxytocin for > 3 h (OR 1.39, 95% CI 0.42-4.55; P = 0.59).
Conclusions: Carbetocin (100 mcg IV) does not reduce the need for second-line uterotonics compared to variable doses of oxytocin (20-60 IU IV) during 3rd stage of labor in parturients undergoing a CD for labor dystocia previously exposed to intrapartum oxytocin. These results do not support the hypothesis, but are consistent with a recent study comparing the in vitro effect of carbetocin and oxytocin in pregnant human myometrium .
1 Leduc D. Obstet Gynaecol Can 2009
2 Cole NM. Anesthesiology 2016