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Intravenous carbetocin versus intravenous oxytocin for preventing atonic postpartum hemorrhage after normal vaginal delivery in high-risk singleton pregnancies: a triple-blind randomized controlled trial

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To compare the effectiveness of intravenous carbetocin to that of intravenous oxytocin for prevention of atonic postpartum hemorrhage (PPH) after vaginal delivery in high-risk singleton pregnancies.

Methods

This triple-blind randomized controlled trial included singleton pregnant women who delivered at Siriraj Hospital between August 2016 and January 2017 and who were 20 years or older, had a gestational age of at least 34 weeks, had a vaginal delivery, and had at least one risk factor for atonic postpartum hemorrhage. Immediately after vaginal delivery, participants were randomly assigned to receive either 5 U of oxytocin or 100 mcg of carbetocin intravenously. Postpartum blood loss was measured objectively in mL using a postpartum drape with a calibrated bag.

Results

A total of 174 and 176 participants constituted the oxytocin and carbetocin groups, respectively. The baseline characteristics were comparable between the groups. The carbetocin group had less postpartum blood loss (146.7 ± 90.4 vs. 195.1 ± 146.2 mL; p < 0.01), a lower incidence of atonic PPH (0 vs. 6.3%; p < 0.01), less usage of additional uterotonic drugs (9.1 vs. 27.6%; p < 0.01), and a lower incidence of postpartum anemia (Hb ≤ 10 g/dL) (9.1 vs. 18.4%; p < 0.05) than the oxytocin group. No significant differences regarding side effects were evident between the groups.

Conclusions

Intravenous carbetocin is more effective than intravenous oxytocin for the prevention of atonic PPH among singleton pregnancies with at least one risk factor for PPH.

Clinical trial registration

TCTR20160715004.

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Acknowledgements

The authors gratefully acknowledge Mr. Suthipol Udompunthurak for assistance with the statistical analysis. We are also grateful to a grant obtained from the Siriraj Research Development Fund, which is managed by the Routine to Research Project (R2R) and to 100 doses of carbetocin used in this study which were supported unconditionally by Ferring Pharmaceutical Ltd., Thailand.

Funding

This study was funded by the Siriraj Research Development Fund, which is managed by the Routine to Research Project (R2R; Grant number 16OG00021/044/16). The one hundred doses of carbetocin used in this study were provided unconditionally by Ferring Pharmaceutical Ltd., Thailand. The funders had no role in the processes of the study design, data collection, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Paweena Amornpetchakul, Tripop Lertbunnaphong, Dittakarn Boriboonhiransarn, Jarunee Leetheeragul, Ratree Sirisomboon & Ratchada Jiraprasertwong

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  1. Paweena Amornpetchakul
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  2. Tripop Lertbunnaphong
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  3. Dittakarn Boriboonhiransarn
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  4. Jarunee Leetheeragul
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  5. Ratree Sirisomboon
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  6. Ratchada Jiraprasertwong
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Contributions

TL: protocol/project development, data analysis and interpretation, manuscript writing/editing, final form of manuscript. PA: data collection and management, manuscript writing, funding management. DB: protocol/project development, data analysis and interpretation. JL: data collection and management. RS: data collection and management. RJ: data collection and management, funding management.

Corresponding author

Correspondence to Tripop Lertbunnaphong.

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Conflict of interest

Assistant professor Tripop Lertbunnaphong has received a speaker honorarium from Ferring Pharmaceutical Ltd., Thailand. Paweena Amornpetchakul, Dittakarn Boriboonhiransarn, Jarunee Leetheeragul, Ratree Sirisomboon and Ratchada Jiraprasertwong declare that they have no conflict of interest.

Research involving human participants and/or animals

Ethics approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Amornpetchakul, P., Lertbunnaphong, T., Boriboonhiransarn, D. et al. Intravenous carbetocin versus intravenous oxytocin for preventing atonic postpartum hemorrhage after normal vaginal delivery in high-risk singleton pregnancies: a triple-blind randomized controlled trial. Arch Gynecol Obstet 298, 319–327 (2018). https://doi.org/10.1007/s00404-018-4806-5

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