Highlights
- •Carbetocin is superior to oxytocin against postpartum hemorrhage in mixed populations.
- •Data were analysed only from patients having elective caesarean deliveries.
- •Trial sequential analysis showed carbetocin reduced need for additional uterotonics.
- •Additional trials are needed to show the effect of carbetocin on bleeding-related outcomes.
Abstract
Background
Carbetocin has been found to be superior to oxytocin in terms of need for additional
uterotonics and prevention of postpartum haemorrhage at caesarean delivery. However,
this is based on combined data from labouring and non-labouring parturients and it
remains unclear how effective carbetocin is in the purely elective setting. The aim
of this review was to compare carbetocin to oxytocin in elective caesarean delivery.
Methods
Medline, Embase, CINAHL, Web of Science, and the Cochrane databases were searched
for randomised controlled trials in any language. The primary outcome was need for
additional uterotonics. Secondary outcomes were mean blood loss, need for blood transfusion
and incidence of postpartum haemorrhage >1000 mL.
Results
Nine studies with a total of 1962 patients were included. Trial sequential analysis
confirmed that the information size (n=1692) had surpassed that required (n=1166)
in order to demonstrate a statistically significant reduction in the use of additional
uterotonics. Need for additional uterotonics was reduced by 53% with carbetocin compared
to oxytocin (OR 0.47, 95% CI 0.34 to 0.64; P <0.001, I2=63.5). The number needed-to-treat was 11. The risk of bias, data heterogeneity and
inconsistency in reporting bleeding outcomes made it difficult to reach definite conclusions
about prevention of PPH.
Conclusions
Carbetocin is associated with a reduced need for additional uterotonics when compared
with oxytocin at elective caesarean delivery. Standardisation of bleeding-related
outcomes in studies is necessary to facilitate synthesis of data in future analyses.
Keywords
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Article info
Publication history
Published online: June 24, 2019
Accepted:
June 16,
2019
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
