Carbetocin versus Rectal Misoprostol to Decrease Blood Loss in Vaginal Delivery in High Risk Patients for Postpartum Hemorrhage

Abstract

Background: Postpartum hemorrhage is a critical complication after delivery. Methods to decrease or prevent postpartum hemorrhage continue to develop. The medical prophylaxis is frequently used with extension of the utilized drugs.Aim of the work: The current study aims to evaluate the effects of intravenous carbetocin versus rectal misoprostol to decrease blood loss in vaginal delivery in high risk patients for postpartum hemorrhage.Patients and Methods: The study included 94 Patients. They were selected from those attending for normal vaginal delivery and categorized as high risk for postpartum hemorrhage. All were evaluated on clinical basis, laboratory investigations and abdominal ultrasound. Then patients were randomly assigned into two equal groups; group A [Carbetocin group] received 1 ampoule of Carbetocin [100 μg/ml] intravenously as a bolus injection slowly over one minute after neonatal delivery, and group B [Misoprostol group] received three rectal misoprostol tablets [600 μg] after neonatal delivery. Each group was assessed for hemodynamic changes [blood pressure, pulse and respiratory rate], gastrointestinal [GIT] side effects as nausea, vomiting and metallic taste, vasomotor effects as flushing, headache, itching.Results: The amount of blood loss was significantly lower in the carbetocin group than in the misoprostol group [365.53±41.12 ml vs. 404.68±67.27 ml]. Need for uterotonics reported among 17.0% of misoprostol group compared to none [0.0%] in carbetocin group [P=0.003]. On the other side, need for blood transfusion and uterine massage was also increased in misoprostol than carbetocin groups, but the difference was not statistically significant. The complications [drug side effects] revealed that, there was significant increase of fever, nausea & vomiting, diarrhea and abdominal pain in misoprostol than carbetocin group [21.3%, 10.6%, 19.14% and 21.3% vs. 0.0%, 0.0%, 2.12% and 0.0% successively].Conclusion: Carbetocin is superior to misoprostol for postpartum hemorrhage, regarding efficacy and safety.

Keywords

• postpartum
• hemorrhage
• carbetocin
• misoprostol
• vaginal delivery