Haemodynamic effects of oxytocin versus carbetocin given as intravenous bolus to parturient undergoing caesarean delivery under spinal anaesthesia
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Date
2014
Authors
Mohd Mahdzir, Fithriah
Journal Title
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Volume Title
Publisher
Universiti Sains Malaysia
Abstract
Introduction : Postpartum haemorrhage (PPH) is one of the commonest causes of maternal morbidity and mortality. Uterine atony has been showed to be the cause of the most postpartum haemorrhage cases. In 2009 World Health Organization (WHO) in booklet for Prevention of Postpartum Haemorrhage has highly recommended active management of third stage of labour in attempt to reduce the incidence of postpartum haemorrhage by using uterotonic agents like oxytocin or carbetocin as part of active management of third stage of labour is highly recommended to prevent post partum haemorhhage. These medications can affect haemodynamic parameters including reduce in blood pressure and increase in heart rate. Carbetocin is an uterotonic agents licensed to be used in Malaysian Health Ministry since 2011.
Objective: The aim of this study were to compare the haemodynamic changes of carbetocin versus oxytocin on maternal hemodynamic parameters during caesarean section. This study also evaluate the side effects profile of both research drugs including comparing estimated blood loss during caesarean delivery when using either oxytocin or carbetocin.
Patients and Method: This is a prospective, randomized double blind study. There were one hundred twenty patients undergoing elective or emergency lower segment caesarean section under spinal anaesthesia. There were randomized to receive either IV oxytocin 5 IU or IV carbetocin 100 μg after delivery of baby. Vasopressor such as ephedrine or phenylephrine were advocated to maintain blood pressure at least around 15% of baseline before research drug is given. We compare the haemodynamic parameters such SBP, DBP, MAP and HR. The side effects profile also has been compared including the need of additional uterotonic agents
Results: It has been observed that there were reduction in systolic and diastolic blood pressure after both drugs are given however there were no statistically significant value between both drug’s group (p > 0.05). Mean arterial pressure as well as heart rate also affected but the difference was not statistically significant. Estimated blood loss in group carbetocin were less (410.6 ± 142.3) and statistically significant when compared to group oxytocin (433.8 ± 258.4), p < 0.05. This study revealed that there were no significant differences in term of uterine tone score, side effects profile and need for additional uterotonics agents.
Conclusion : We conclude that there were rapid onset and offset of undesirable haemodynamic effects of either oxytocin 5 IU or carbetocin and the difference between oxytocin 5 IU and 100 μg carbetocin were minor and statistically not significant. The side effects profiles of both drugs are similar and not significant while it is proven that usage of carbetocin cause less blood loss compared to oxytocin. There were no significant values in usage of additional uterotonic agents between group oxytocin and carbetocin.
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Keywords
Postpartum haemorrhage (PPH)