Obstetrics and Gynecology Department, Kasr Al Aini Hospital, Cairo University, Cairo, Egypt.
Int J Gynaecol Obstet. 2020 Feb;148(2):238-242. doi: 10.1002/ijgo.13056. Epub 2019 Dec 2.
To compare effectiveness and safety of carbetocin and misoprostol for prevention of postpartum hemorrhage (PPH) among low-risk women.
Randomized controlled trial among 150 pregnant women with low risk of PPH admitted for vaginal delivery at Kasr Al Ainy Hospital, Cairo, Egypt, between July 2018 and May 2019. Participants were assigned to two groups by a web-based randomization system ensuring allocation concealment. After neonatal delivery, the carbetocin group received one ampoule of carbetocin (100 μg/mL) intravenously and the misoprostol group received two rectal tablets of misoprostol (800 μg) for active management of the third stage. Blood pressure, blood loss, and hemoglobin levels were monitored. The primary outcome measure was need for additional uterotonic drugs.
The carbetocin group had significantly less blood loss (P<0.001), shorter third stage (P<0.001), and less need for additional uterotonics (P=0.013) or uterine massage (P=0.007). The two drugs were hemodynamically safe. Hemoglobin levels after delivery were comparable in the two groups (P=0.475). Adverse effects were more common in the misoprostol group (P<0.001).
Among low-risk women, carbetocin seems to be a better alternative to misoprostol for active management of the third stage of labor; it reduced blood loss and use of additional uterotonic drugs. CLINICALTRIALS.GOV: NCT03556852.
比较卡贝缩宫素与米索前列醇预防低危产妇产后出血（PPH）的有效性和安全性。
在埃及开罗 Kasr Al Ainy 医院，2018 年 7 月至 2019 年 5 月间，对 150 名低 PPH 风险的阴道分娩孕妇进行了一项随机对照试验。通过基于网络的随机系统将参与者分配到两组，以确保分配隐匿。新生儿娩出后，卡贝组静脉注射 1 支卡贝缩宫素（100μg/mL），米索组直肠给予 2 片米索前列醇（800μg），以积极管理第三产程。监测血压、出血量和血红蛋白水平。主要结局指标为需要额外使用宫缩剂。
卡贝组出血量明显减少（P<0.001），第三产程更短（P<0.001），需要额外使用宫缩剂（P=0.013）或子宫按摩（P=0.007）的情况更少。两种药物在血液动力学上均安全。两组产后血红蛋白水平相当（P=0.475）。米索组不良反应更常见（P<0.001）。
在低危产妇中，卡贝缩宫素似乎是替代米索前列醇积极管理第三产程的更好选择；它减少了出血量和额外宫缩剂的使用。临床试验.gov：NCT03556852。
