Carbetocin versus rectal misoprostol for management of third stage of labor among women with low risk of postpartum hemorrhage

摘要

Abstract Objective To compare effectiveness and safety of carbetocin and misoprostol for prevention of postpartum hemorrhage ( PPH ) among low‐risk women. Methods 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. Results 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). Conclusion 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