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Carbetocin as first line uterotonic in all categories of caesarean delivery? A five year retrospective analysis
Abstract Number: F3H-71
Abstract Type: Original Research
Carbetocin is used to reduce the incidence of postpartum haemorrhage (PPH) in caesarean deliveries (CD). In vitro studies show its efficacy is reduced when it is used on pre-exposed myometrium therefore its use is only recommended in elective CD.1,2 We performed a retrospective analysis to assess whether the use of carbetocin in all categories of CD had any impact on rates and severity of PPH in our parturients.
Data were extracted from the Euroking© database and patients were allocated into groups according to first line uterotonic, grade of CD and whether labour was augmented. Mean blood loss (MBL), incidence of major obstetric haemorrhage greater than 1000 mls (MOH) and the use of additional uterotonics were compared between groups. Variables such as age, body mass index (BMI) and parity were also collected. Data were analysed using student-T test and Chi-square test.
6040 caesarean deliveries were included in our analysis, of which 2098 (40.4% elective; 59.6% emergent) received oxytocin and 3942 (52.9% elective; 47.1% emergent) received carbetocin. In the emergent cohort, 34.2% had received augmentation. A statistically significant difference was found in emergent CD where carbetocin was superior to oxytocin (MBL: 655 mls vs 677 mls, p<0.01; MOH: 10.4% vs 13.7%, p<0.01).There was no difference between uterotonics in elective CD or when labour was augmented. Use of carbetocin significantly reduced the need for additional uterotonics both in elective (8.4% vs 15.9%, p<0.01) and emergent (10.4% vs 31.9%, p<0.01) CD (Table 1). Mean age was higher in the oxytocin group (35.3 vs 34.2, p<0.01) but BMIs were similar between the two groups (26.5 vs 26.7, p=0.54). There was a significant difference in the distribution of parity (oxytocin vs carbetocin: 21% vs 13% nulliparas, p<0.01; 43% vs 58% multiparas, p<0.01).
Our analysis indicates that carbetocin is non-inferior to oxytocin in preventing PPH in elective CD. However, in emergency CD, in contrast to in-vitro studies, carbetocin was found to be more effective than oxytocin in reducing MBL and incidence of MOH, although this may not be clinically significant. Carbetocin reduced the need for further uterotonics when compared to oxytocin in all CD.
1. Leduc D. et al. Active management of the third stage of labour. J Obstet Gynaecol Can 2009;31:980–93.
2. Nguyen-Lu et al. Carbetocin at caesarean delivery for labour arrest. Can J Anaesth. 2015 Aug;62(8):866-74.