Erkan Kalafat1,2,3,4, Ali Gokce1, Pat O'Brien5, Can Benlioglu1, Acar Koc1, Onur Karaaslan3, Asma Khalil4,6. 1. Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara University, Ankara, Turkey. 2. Department of Statistics, Middle East Technical University, Ankara, Turkey. 3. Hakkari State Hospital, Hakkari, Turkey. 4. Fetal Medicine Unit, St. George's Hospital, St. George's University of London, London, UK. 5. Institute for Women's Health, University College London, London, UK. 6. Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St. George's University of London, London, UK.
Abstract
OBJECTIVES: To evaluate the efficacy of carbetocin for the prevention of postpartum hemorrhage (PPH) and related events after vaginal or cesarean delivery. METHODS: Medline, Scopus, Embase, and the Cochrane Library were searched in February 2018 using combinations of the relevant MeSH terms, keywords. Randomized studies, comparing carbetocin to any other uterotonic agent, in the management of cesarean and vaginal deliveries, were conducted. Two reviewers independently extracted the data. A random-effects meta-analysis was used for quantitative synthesis. Also, Bayesian random-effect metaregression was used to estimate the posterior probabilities (PP) for benefits of carbetocin use. RESULTS: After the full-text review, 30 trials were included in the meta-analysis. Compared to oxytocin, carbetocin was associated with a reduced need for additional uterotonic use in women undergoing cesarean delivery (RR 0.43, 95% CI 0.30-0.59, I2 = 71%, 3216 women, PP > 99.9%). Women at high risk of PPH delivering vaginally also had a reduced need for additional uterotonic use with carbetocin compared to oxytocin (RR 0.56, 95% CI 0.34-0.94, I2 = 38%, 789 women, PP = 81.2%). The risk of postpartum blood transfusion (RR 0.57, 95% CI 0.33-0.96, I2 = 0%, 1991 women, PP = 97.9%) was also less with carbetocin compared to oxytocin in high-risk women undergoing cesarean delivery. The risk of PPH was similar between carbetocin and other uterotonic agents for both cesarean (RR 0.69, 95% CI 0.45-1.05, I2 = 27%, 2926 women, PP = 96.3%) and vaginal deliveries (RR 0.61, 95% CI 0.32-1.14, I2 = 35%, 1515 women, PP = 88.9%). CONCLUSIONS: Carbetocin is effective in reducing the need for additional uterotonic use and postpartum blood transfusion in women at increased risk of PPH undergoing cesarean delivery. There is still a need for high-quality trials on its effectiveness in preventing PPH in high-risk women.PrecisCarbetocin is effective in reducing the need for additional uterotonic use and postpartum blood transfusion in high-risk women undergoing Cesarean delivery.
OBJECTIVES: To evaluate the efficacy of carbetocin for the prevention of postpartum hemorrhage (PPH) and related events after vaginal or cesarean delivery. METHODS: Medline, Scopus, Embase, and the Cochrane Library were searched in February 2018 using combinations of the relevant MeSH terms, keywords. Randomized studies, comparing carbetocin to any other uterotonic agent, in the management of cesarean and vaginal deliveries, were conducted. Two reviewers independently extracted the data. A random-effects meta-analysis was used for quantitative synthesis. Also, Bayesian random-effect metaregression was used to estimate the posterior probabilities (PP) for benefits of carbetocin use. RESULTS: After the full-text review, 30 trials were included in the meta-analysis. Compared to oxytocin, carbetocin was associated with a reduced need for additional uterotonic use in women undergoing cesarean delivery (RR 0.43, 95% CI 0.30-0.59, I2 = 71%, 3216 women, PP > 99.9%). Women at high risk of PPH delivering vaginally also had a reduced need for additional uterotonic use with carbetocin compared to oxytocin (RR 0.56, 95% CI 0.34-0.94, I2 = 38%, 789 women, PP = 81.2%). The risk of postpartum blood transfusion (RR 0.57, 95% CI 0.33-0.96, I2 = 0%, 1991 women, PP = 97.9%) was also less with carbetocin compared to oxytocin in high-risk women undergoing cesarean delivery. The risk of PPH was similar between carbetocin and other uterotonic agents for both cesarean (RR 0.69, 95% CI 0.45-1.05, I2 = 27%, 2926 women, PP = 96.3%) and vaginal deliveries (RR 0.61, 95% CI 0.32-1.14, I2 = 35%, 1515 women, PP = 88.9%). CONCLUSIONS: Carbetocin is effective in reducing the need for additional uterotonic use and postpartum blood transfusion in women at increased risk of PPH undergoing cesarean delivery. There is still a need for high-quality trials on its effectiveness in preventing PPH in high-risk women.PrecisCarbetocin is effective in reducing the need for additional uterotonic use and postpartum blood transfusion in high-risk women undergoing Cesarean delivery.