Yantai Yuhuangding Hospital, Yantai, China.
Taihe Country People's Hospital, Taihe, China.
J Obstet Gynaecol Res. 2022 Apr;48(4):889-901. doi: 10.1111/jog.15174. Epub 2022 Mar 3.
This study compared the effectiveness and safety of carbetocin and oxytocin in preventing postpartum hemorrhage (PPH).
A systematic literature search was performed on PubMed, Embase, and the Cochrane Library for relevant studies published up to February 2019. Next, two independent reviewers screened the studies according to the selection criteria as well as the strategies recommended by the Cochrane Collaboration. Data were then extracted and evaluated. All statistical analyses were performed using RevMan 5.1.
A total of 24 studies involving 37 383 patients were included for analysis. For cesarean section patients, carbetocin was superior to oxytocin in reduction of the need for additional uterine contraction (odds ratio [OR] = 0.48, 95% confidence interval [CI] [0.35, 0.65], p < 0.00001), PPH (OR = 0.70, 95% CI [0.51, 0.95], p = 0.02), blood loss (mean [MD] = -64.36, 95% CI [-107.78, -20.93], p = 0.004), and transfusion (OR = 0.59, 95% CI [0.42, 0.82], p = 0.002), and there was no significant difference in severe PPH (OR = 0.84, 95% CI [0.66, 1.090], p = 0.19). For vaginal delivery patients, carbetocin was superior to oxytocin in reduction of the need for additional uterine contractions (OR = 0.48, 95% CI [0.25, 0.93], p = 0.03), PPH (OR = 0.28, 95% CI [0.09, 0.91], p = 0.03), and blood loss (MD = -63.52, 95% CI [-113.43, -13.60], p = 0.01), and there were no significant differences in severe PPH (OR = 0.82, 95% CI [0.40, 1.69], p = 0.59) and transfusion (OR = 0.60, 95% CI [0.22, 1.61], p = 0.31). With regard to safety, for cesarean section patients, carbetocin was superior to oxytocin in reduction of the incidence of headache (OR = 0.72, [0.55, 0.95], p = 0.02), and there were no significant differences in nausea, vomiting, abdominal pain, flushing, tremors, itching, dizziness, and fever. For vaginal delivery patients, there were no significant differences in nausea, vomiting, headache, abdominal pain, flushing, tremors, itching, dizziness, and fever between the two drugs.
For patients undergoing cesarean section and vaginal delivery, carbetocin was superior to oxytocin in effectiveness and similar in safety. Therefore, carbetocin is expected to be an alternative uterine contraction agent for preventing PPH.
本研究比较了卡贝缩宫素和缩宫素在预防产后出血（PPH）方面的有效性和安全性。
系统检索 PubMed、Embase 和 Cochrane 图书馆中截至 2019 年 2 月发表的相关研究。然后，两名独立的审查员根据选择标准以及 Cochrane 协作组推荐的策略筛选研究。接着提取和评估数据。所有统计分析均使用 RevMan 5.1 进行。
共纳入 24 项研究，涉及 37383 例患者。对于剖宫产患者，卡贝缩宫素在减少需要额外子宫收缩药物（比值比 [OR] = 0.48，95%置信区间 [CI] [0.35, 0.65]，p < 0.00001）、PPH（OR = 0.70，95% CI [0.51, 0.95]，p = 0.02）、出血量（均值 [MD] = -64.36，95% CI [-107.78, -20.93]，p = 0.004）和输血（OR = 0.59，95% CI [0.42, 0.82]，p = 0.002）方面优于缩宫素，且严重 PPH（OR = 0.84，95% CI [0.66, 1.090]，p = 0.19）方面无显著差异。对于阴道分娩患者，卡贝缩宫素在减少需要额外子宫收缩药物（OR = 0.48，95% CI [0.25, 0.93]，p = 0.03）、PPH（OR = 0.28，95% CI [0.09, 0.91]，p = 0.03）和出血量（MD = -63.52，95% CI [-113.43, -13.60]，p = 0.01）方面优于缩宫素，且严重 PPH（OR = 0.82，95% CI [0.40, 1.69]，p = 0.59）和输血（OR = 0.60，95% CI [0.22, 1.61]，p = 0.31）方面无显著差异。关于安全性，对于剖宫产患者，卡贝缩宫素在降低头痛发生率方面优于缩宫素（OR = 0.72，[0.55, 0.95]，p = 0.02），且在恶心、呕吐、腹痛、潮红、震颤、瘙痒、头晕和发热方面无显著差异。对于阴道分娩患者，两种药物在恶心、呕吐、头痛、腹痛、潮红、震颤、瘙痒、头晕和发热方面无显著差异。
对于行剖宫产和阴道分娩的患者，卡贝缩宫素在有效性方面优于缩宫素，且安全性相似。因此，卡贝缩宫素有望成为预防 PPH 的一种替代子宫收缩药物。
