Oxytocin agonists for preventing postpartum haemorrhage

Area of Science:

• Obstetrics and Gynecology
• Pharmacology

Background:

• Postpartum hemorrhage (PPH) is a leading cause of maternal mortality globally.
• Active management of the third stage of labor is crucial for PPH prevention.
• Carbetocin, an oxytocin agonist, is being investigated as a potential PPH preventative agent.

Purpose of the Study:

• To evaluate the efficacy of oxytocin agonists (carbetocin) versus conventional uterotonics for PPH prevention.
• To determine optimal administration routes and doses for oxytocin agonists in PPH prevention.

Main Methods:

• Systematic review of randomized controlled trials comparing carbetocin with other uterotonics or placebo.
• Searches conducted in Cochrane, MEDLINE, and EMBASE databases.
• Data extraction and quality assessment performed independently by two reviewers.

Main Results:

• Four studies involving 1037 women were included (caesarean and vaginal deliveries).
• Carbetocin demonstrated a significant reduction in the need for additional uterotonic agents and uterine massage compared to oxytocin in caesarean deliveries.
• No significant differences in PPH risk or adverse effects were observed between carbetocin and oxytocin.

Conclusions:

• Insufficient evidence exists to definitively state that 100 mcg intravenous carbetocin is as effective as oxytocin for PPH prevention.
• Carbetocin use was linked to a decreased need for supplementary uterotonics and uterine massage compared to oxytocin.
• Limited comparative data on adverse events between carbetocin and oxytocin were available.