Comparison of efficacy of Carbetocin versus Oxytocin in the prevention of Postpartum hemorrhage An open label randomized controlled trial

According to American College of Obstetrician and Gynecology, Postpartum hemorrhage is defined as a cumulative blood loss of more than 1000ml with signs and symptoms of hypovolemia within 24 hours of birth process, regardless of route of delivery. Primary PPH is defined as blood loss of more than 500ml after vaginal delivery and more than 1000ml after cesarean section which occurs in first 24 hours after delivery. It constitutes a major cause of maternal morbidity and mortality and complicates approximately 6% of all deliveries. It is the leading cause of maternal mortality and account for 1,25,000 deaths per year worldwide. PPH incidence in India is 2-2.5% of vaginal deliveries, 6% of cesarean section. About 1 woman dies in every 2 minutes, most of these deaths are preventable.

Causes of PPH-

1. Tone (uterine atony)- 70% cases

2. Trauma (laceration,rupture)

3. Tissue (Retained tissue)- causes secondary PPH due to improper uterine retraction

$. Thrombin deficiency (Coagulopathy)

Treatment modalities available for management of PPH-

First line- Medical management- Uterotonics- Inj Oxytocin, Inj Carbetocin, Inj methergine, Tab misoprostol

Uterine tamponade (foley catheter, condom catheter, bakri balloon)

Second line- Surgical management- B lynch sutures, uterine artery ligation, anterior division of internal iliac artery ligation

Arterial embolization

hysterectomy

Oxytocin is frequently used as first choice in cesarean section. Due to its short half life (4-10 minutes), it requires continuous or repeated ad inistration whereas

Carbetocin is a long acting analogue of oxytocin having half life of 40 minutes

Oxytocin is susceptible to heat whereas, Carbetocin is heat stable

There is a paucity of literature regarding comparison of oxytocin and carbetocin, thereforre we plan to conduct a study comp[aring incidence of PPH in postpartum period.

The literature review does not clearly depict the superiority of one study method over other.

Hence, we hypothesize that Carbetocin is equivalent to Oxytocin in prevention of PPH after delivery.

The present hypothesis will be tested using an open label randomized controlled trial (RCT) study design.