Carbetocin versus syntometrine in the prevention of pospartum haemorrhage among women with risk factor following vaginal delivery

Abstract

Postpartum haemorrhage (PPH) is one of the main factors that contribute to maternal morbidity and mortality worldwide. The aim of this study was to compare the efficacy and safety of a single 100μg intramuscular (IM) dose of carbetocin to a single IM dose of syntometrine in the prevention of PPH for patient with at least one risk factor for PPH following vaginal delivery. This study was a double blind randomized controlled study conducted in tertiary centre whereby 140 pregnant women with risk factors of PPH who delivered vaginally. 70 of pregnant women received IM syntometrine and another 70 women received IM carbetocin during third stage of labour. All outcomes measure including, the amount of intrapartum blood loss, haemoglobin differences between pre and 24 hours post-delivery, additional uterotonic agents requirement and drugs side effects were evaluated. All the data were analysed using chi-square test and independent t-test. The amount of intrapartum blood loss was significantly lower in carbetocin group compared to syntometrine group (304.43 ± 192 vs 402.19 ± 265). Besides, the number of women needed additional uterotonic agents was also higher in syntometrine group compared to carbetocin group. 15 women out of 70 needed additional uterotonic agents in syntometrine group compared to 5 women in carbetocin group and it was statistically significant (15/70 vs 5/70, p value < 0.016). The number of women developed PPH (EBL more than 500mL) was also higher in syntometrine group compared to carbetocin group and it was statistically significant (22.9% vs 10%, p value 0.04). However, there was no significant difference regarding the incidence of major PPH, blood transfusion requirement and haemoglobin differences. There were also lower incidence of drug side effects in carbetocin group compared to syntometrine group (5/70 vs. 23/70). This study showed that IM carbetocin is more effective in reducing the intrapartum blood loss. Thus it is benefit in prevention of PPH among high-risk pregnant women who delivered vaginally.