Faculty of Medicine, University of Aachen RWTH, 52074 Aachen, Germany.
Eur J Obstet Gynecol Reprod Biol. 2009 Nov;147(1):15-20. doi: 10.1016/j.ejogrb.2009.06.018. Epub 2009 Jul 17.
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.
67-80%的病例是由子宫收缩乏力引起的。预防措施包括产后使用预防性药物来辅助子宫收缩，从而避免严重失血，并降低产妇发病率和死亡率。卡贝缩宫素是一种合成的催产素类似物，半衰期比催产素长约 4-10 倍。它结合了催产素的安全性和耐受性，以及注射用麦角生物碱的持续子宫收缩活性。此外，卡贝缩宫素可以作为单次静脉或肌肉注射给药，而不是像催产素那样需要输注数小时。卡贝缩宫素目前被批准用于椎管内麻醉下剖宫产术后预防子宫收缩乏力。三项剖宫产随机对照试验和一项荟萃分析的数据表明，与安慰剂或催产素相比，卡贝缩宫素显著减少了对额外子宫收缩剂或子宫按摩的需求，以预防过度出血。接受卡贝缩宫素或催产素的女性头痛、震颤、低血压、潮红、恶心、腹痛、瘙痒和温暖感的风险相似。两项更新的双盲随机试验和一项回顾性研究的结果表明，卡贝缩宫素也可能是预防阴道分娩后产后出血的传统子宫收缩剂的良好替代品。与催产素相比，高危女性使用卡贝缩宫素的额外子宫收缩剂需求减少，卡贝缩宫素在低危女性中的有效性至少与欣母沛相当。在这些阴道分娩研究中，卡贝缩宫素与不良反应发生率低有关，并表现出比欣母沛更好的耐受性。与单独静脉注射催产素相比，卡贝缩宫素的作用持续时间更长，与欣母沛相比，心血管副作用谱更好。除了作为预防剖宫产产后出血的有效治疗方法外，卡贝缩宫素也可能成为高危女性和患有妊娠高血压疾病的女性阴道分娩后预防产后出血的首选药物。子痫前期仍然是欧盟使用卡贝缩宫素的禁忌症，在提倡在子痫前期患者中常规使用卡贝缩宫素之前，还需要进一步研究其心血管效应。还需要进一步研究评估在低危女性中，预防性卡贝缩宫素是否优于常规子宫收缩剂。
