Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université Paris Cité, Paris, France.
Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service de Gynécologie Obstétrique, Paris, France.
Int J Gynaecol Obstet. 2023 Sep;162(3):889-894. doi: 10.1002/ijgo.14743. Epub 2023 Mar 10.
To compare the effectiveness of prophylactic carbetocin with prophylactic oxytocin for preventing severe postpartum hemorrhage (PPH) following vaginal delivery.
This before and after cohort study took place between 2020 and 2021 in a university maternity hospital. In 2021, the protocol for PPH prevention immediately after vaginal delivery changed: intravenous oxytocin (5 IU) was replaced by intravenous carbetocin (100 μg). All patients with vaginal births were included, with two groups compared: patients who received prophylactic oxytocin in 2020 and those who received prophylactic carbetocin in 2021. The primary outcome was severe PPH, defined as one or more of the following: estimated blood loss ≥1500 mL, transfusion ≥4 units of red blood cells, Bakri balloon use, embolization, vascular ligation, hysterectomy, and maternal death.
Among 4832 women included, 2417 received oxytocin and 2415 received carbetocin. The rate of severe PPH was similar in both groups (0.5% vs. 0.6%, respectively; adjusted odds ratio, 0.8 [95% confidence interval, 0.4-1.8]). The rate of PPH ≥500 mL was lower in the carbetocin group (4% vs. 5.8%; P = 0.004).
Although prophylactic carbetocin was associated with a reduction in the rate of PPH ≥500 mL, carbetocin is no different to oxytocin in preventing severe PPH caused by atony after vaginal delivery.
比较卡贝缩宫素与催产素预防性应用于阴道分娩后预防严重产后出血（PPH）的效果。
本项回顾性队列研究于 2020 年至 2021 年在一所大学附属医院进行。2021 年，阴道分娩后 PPH 预防方案发生变化：静脉滴注催产素（5IU）改为静脉滴注卡贝缩宫素（100μg）。所有阴道分娩患者均纳入研究，比较两组患者：2020 年接受预防性催产素的患者和 2021 年接受预防性卡贝缩宫素的患者。主要结局为严重 PPH，定义为以下一种或多种情况：估计出血量≥1500mL、输血≥4 单位红细胞、使用 Bakri 球囊、栓塞、血管结扎、子宫切除术和产妇死亡。
共纳入 4832 例患者，其中 2417 例接受催产素，2415 例接受卡贝缩宫素。两组严重 PPH 发生率相似（分别为 0.5%和 0.6%；校正比值比，0.8[95%置信区间，0.4-1.8]）。卡贝缩宫素组 PPH≥500mL 的发生率较低（4% vs. 5.8%；P=0.004）。
尽管预防性应用卡贝缩宫素可降低 PPH≥500mL 的发生率，但卡贝缩宫素在预防阴道分娩后宫缩乏力引起的严重 PPH 方面与催产素无差异。
