Carbetocin Versus Oxytocin: A Systematic Review of Randomized Control Trials for the Future of Maternal Morbidity & Mortality in the US
Renowned American obstetrician, Joseph DeLee, so eloquently described its indelible fury using candor and conclusive frankness, “Postpartum hemorrhage is the obstetric emergency, for here more depends on quick perception, rapid judgment and swift action than in any other condition incident to pregnancy” (DeLee, 1899). PPH is characterized by excessive blood loss during delivery and is defined by the American College of Obstetricians as blood loss greater than or equal to 1,000 mL. In the United States, 11.4% of all maternal deaths in 2013 were attributed to PPH, making it the number four cause of death among pregnant women. PPH accounts for substantial amount of maternal near misses or severe morbidity. Furthermore, it is contraction and retraction of interlacing myometrial fibers surrounding the maternal blood vessels of the placenta that allows the control of postpartum bleeding. The “Four Ts” (tone, trauma, tissue and thrombin) are used in the literature to describe the causes of post-partum hemorrhage. Failure of the uterus to contract postpartum, abnormal vasculature of the uterus, incomplete evacuation of a portion of the placenta or other products of conception, deficits within a patient's clotting or coagulation system, and large lacerations in to the genital tract place postpartum women at risk for PPH (Harvey, 2017). Atony is the most common cause of PPH, accounting for nearly 80% of all PPH cases. Thus, the ACOG has accepted the WHO’s guidelines regarding active management of the third stage of labor (AMSTL). Currently administration of uterotonic is recommended best practice for maintaining consistent contractions throughout the third stage. There are three main classes of uterotonic approved for use in the United States. The literature is filled with evidence indicating effectiveness of oxytocin, ergometrine and prosteglandins in the prevention of PPH. Carbetocin is an oxytocin analog with prolonged half-life. It is approved for use in 23 countries but not in the US. This systematic review of randomized control trials comparing oxytocin with carbetocin, was carried out such that policy makers and the FDA might notice the prospective benefit of carbetocin in certain settings throughout the US.
Howard, Jes'Terieuz J, "Carbetocin Versus Oxytocin: A Systematic Review of Randomized Control Trials for the Future of Maternal Morbidity & Mortality in the US" (2018). Texas Medical Center Dissertations (via ProQuest). AAI10790535.