Abstract
Postpartum haemorrhage is the leading cause of maternal mortality worldwide: 67–80%
of cases are caused by uterine atony. Preventive measures include prophylactic drug
use to aid uterine contraction after delivery, thus avoiding severe blood loss and
reducing maternal morbidity and mortality. Carbetocin is a synthetic analogue of oxytocin
with a half-life approximately 4–10 times longer than that reported for oxytocin.
It combines the safety and tolerability profile of oxytocin with the sustained uterotonic
activity of injectable ergot alkaloids. Furthermore, carbetocin can be administered
as a single dose injection either intravenously or intramuscularly rather than as
an infusion over several hours as is the case with oxytocin. Carbetocin is currently
indicated for prevention of uterine atony after delivery by caesarean section in spinal
or epidural anaesthesia. Data from three randomised controlled trials in caesarean
delivery and a meta-analysis indicate that carbetocin significantly reduces the need
for additional uterotonic agents or uterine massage to prevent excessive bleeding
compared with placebo or oxytocin. The risk of headache, tremor, hypotension, flushing,
nausea, abdominal pain, pruritus and feeling of warmth was similar in women who received
carbetocin or oxytocin. The findings from two more recent double-blind randomised
trials and one retrospective study suggest that carbetocin may also represent a good
alternative to conventional uterotonic agents for prevention of postpartum haemorrhage
after vaginal deliveries. A reduced need for additional uterotonics was observed with
carbetocin vs. oxytocin in high-risk women and carbetocin was at least as effective
as syntometrine in low-risk women. In these studies of vaginal deliveries, carbetocin
was associated with a low incidence of adverse effects and demonstrated a better tolerability
profile than syntometrine. Carbetocin had a long duration of action compared with
intravenous oxytocin alone and a better cardiovascular side effect profile compared
with syntometrine. In addition to being an effective treatment for the prevention
of postpartum haemorrhage following caesarean delivery, carbetocin may also become
the drug of choice for postpartum haemorrhage prevention after vaginal delivery in
high-risk women and those who suffer from hypertensive disorders in pregnancy. Preeclampsia
is still a contraindication to the administration of carbetocin in the EU, and further
studies would be required to assess the cardiovascular effects of carbetocin before
it can be advocated for routine use in preeclamptic patients. Further research is
required to assess whether prophylactic carbetocin is superior to conventional uterotonic
agents following vaginal delivery in low-risk women.
Keywords
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Article info
Publication history
Published online: July 08, 2009
Accepted:
June 18,
2009
Received in revised form:
May 13,
2009
Received:
March 12,
2009
Identification
Copyright
© 2009 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
