Carbetocin vs Oxytocin for Postpartum Hemorrhage

Overseen By Mrinalini Balki, MD

Age: 18 - 65

Sex: Female

Trial Phase: Academic

Sponsor: Samuel Lunenfeld Research Institute, Mount Sinai Hospital

Disqualifiers: Heart disease, Bleeding disorder, Anemia, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

Duration: Immediate perioperative period

160 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify if you need to stop taking your current medications. However, if you are on treatment for diabetes or preeclampsia, it seems you can continue those medications as they are part of the inclusion criteria.

What data supports the effectiveness of the drug Carbetocin compared to Oxytocin for preventing postpartum hemorrhage?

Research shows that Carbetocin is effective in preventing postpartum hemorrhage (heavy bleeding after childbirth) in various situations, such as after cesarean sections and vaginal deliveries, especially in high-risk pregnancies. Studies have compared Carbetocin to Oxytocin and found it to be a safe and effective option for managing this condition. ^{1 2 3 4 5}

Is Carbetocin safe for preventing postpartum hemorrhage?

Carbetocin has a similar safety profile to oxytocin, which is commonly used to prevent postpartum hemorrhage, but more research is needed to confirm this. ^{1 3 6 7 8}

How does the drug carbetocin differ from oxytocin for postpartum hemorrhage?

Carbetocin is unique because it is a longer-acting drug compared to oxytocin, which means it may require fewer doses to prevent postpartum hemorrhage (heavy bleeding after childbirth). This can be particularly beneficial in managing bleeding after both cesarean and vaginal deliveries. ^{1 2 3 4 5}

What is the purpose of this trial?

The goal of this study is to compare 2 medications that are commonly used to prevent excess uterine bleeding (postpartum hemorrhage, or PPH) following cesarean delivery (CD), oxytocin and carbetocin. Most of the trials evaluating the preventative role of oxytocin and carbetocin after CD have focused on patient with low-risk of PPH. This trial will focus on patients that are at increased risk of PPH, with risk factors such as: multiple gestation (twins, or more multiples), large baby, polyhydramnios (excess amniotic fluid), history of PPH, body mass index greater than 40, diabetes mellitus, hypertension, and placenta previa. The investigators hypothesize that carbetocin would be more effective than an oxytocin regimen in reducing the risk of PPH in patients undergoing CD with any of the biological high-risk factors.

Research Team

Mrinalini Balki, MD

Principal Investigator

MOUNT SINAI HOSPITAL

Eligibility Criteria

This trial is for women at high risk of heavy bleeding after a cesarean delivery. Risk factors include having twins or more, a large baby, too much amniotic fluid, previous heavy bleeding after birth, obesity (BMI over 40), diabetes, high blood pressure, and placenta previa.

Inclusion Criteria

Any one or more of the risk factors for uterine atony: Overdistended uterus due to polyhydramnios (amniotic fluid index >24 cm), fetal macrosomia reported on prenatal ultrasound >90th centile or > 4000 gm, multiple gestation, history of uterine atony/PPH (documented with blood loss of >1000 ml, blood transfusion, use of surgical methods such as Bakri balloon, B-Lynch sutures, uterine artery ligation or embolization), obesity with body mass index (BMI) >40 kg/m2, diabetes mellitus, hypertensive disease (chronic hypertension or severe preeclampsia on treatment), placenta previa

Exclusion Criteria

Placenta accreta spectrum

I have a bleeding disorder.

Anemia (<100 g/dl)

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either carbetocin or oxytocin during cesarean delivery to prevent postpartum hemorrhage

Immediate perioperative period

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, including assessment of blood loss and uterine tone

24 hours

1 visit (in-person)

Long-term follow-up

Participants are monitored for any long-term effects or complications post-delivery

4 weeks

Treatment Details

Interventions

• Carbetocin
• Oxytocin

Trial Overview The study compares two drugs used to prevent excessive bleeding post-cesarean: oxytocin and carbetocin. It specifically looks at their effectiveness in women with higher chances of postpartum hemorrhage due to certain health conditions.

Participant Groups

Group I: Oxytocin 5IU Active Control 1 Intervention

IV oxytocin 5 IU diluted in 10 mL normal saline over 1 min followed by continuous infusion of 250 mIU/min over 4 hours.

Group II: Carbetocin 100mcg Active Control 1 Intervention

IV carbetocin 100 mcg diluted in 10 mL normal saline over 1 min followed by placebo infusion for 4 hours after the delivery of the fetus.

Who Is Running the Clinical Trial?

Samuel Lunenfeld Research Institute, Mount Sinai Hospital

Lead Sponsor

Trials

132

Recruited

11,400+

Findings from Research

In a study of 160 hypertensive pregnant women undergoing cesarean section, carbetocin was found to significantly reduce postoperative blood loss compared to oxytocin, with blood loss averaging 424.75 ml in the carbetocin group versus 679.5 ml in the oxytocin group.

Carbetocin also maintained hemoglobin levels post-delivery, while oxytocin led to a significant decrease in hemoglobin, indicating that carbetocin may be a safer option for preventing postpartum hemorrhage in this patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Carbetocin versus oxytocin for prevention of postpartum hemorrhage in hypertensive women undergoing elective cesarean section. Ibrahim, ZM., Sayed Ahmed, WA., Abd El-Hamid, EM., et al.[2021]

Carbetocin was found to be more effective than oxytocin in preventing postpartum hemorrhage (PPH) after cesarean sections, as it significantly reduced the need for additional uterotonics (75% for oxytocin vs. 33% for carbetocin).

Patients with a higher pre-pregnancy BMI (≥25) required more additional treatment after receiving carbetocin compared to oxytocin, indicating that further research is needed to understand the effects of BMI on treatment efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Comparison of carbetocin and oxytocin effectiveness for prevention of postpartum hemorrhage after caesarean delivery]. Brzozowska, M., Lisiecki, D., Kowalska-Koprek, U., et al.[2019]

In a study of 100 women, carbetocin was found to be more effective than oxytocin in reducing blood loss and the need for additional uterotonics during the management of atonic postpartum hemorrhage after vaginal delivery.

Both carbetocin and oxytocin showed similar safety profiles, with no significant differences in side effects or hemodynamic changes, suggesting that carbetocin is a safer alternative for treating this condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Carbetocin versus oxytocin in the management of atonic post partum haemorrhage (PPH) after vaginal delivery: a randomised controlled trial. Maged, AM., Hassan, AM., Shehata, NA.[2018]

In a study involving 350 women at high risk for postpartum hemorrhage, intravenous carbetocin significantly reduced postpartum blood loss compared to intravenous oxytocin (146.7 mL vs. 195.1 mL) and completely prevented atonic PPH, while oxytocin had a 6.3% incidence of this condition.

Carbetocin also led to lower usage of additional uterotonic drugs and a reduced incidence of postpartum anemia, with no significant differences in side effects between the two treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intravenous carbetocin versus intravenous oxytocin for preventing atonic postpartum hemorrhage after normal vaginal delivery in high-risk singleton pregnancies: a triple-blind randomized controlled trial. Amornpetchakul, P., Lertbunnaphong, T., Boriboonhiransarn, D., et al.[2019]

Carbetocin significantly reduced postpartum hemorrhage (PPH) compared to oxytocin, with lower bleeding amounts (337.73 mL vs. 378 mL) and a lower occurrence of PPH (4% vs. 16%) in a study of 200 women.

Carbetocin also resulted in better hemoglobin levels post-delivery and caused fewer hemodynamic changes, making it a safer alternative to oxytocin, despite a higher incidence of tachycardia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Carbetocin versus oxytocin for prevention of postpartum hemorrhage after vaginal delivery in high risk women. Maged, AM., Hassan, AM., Shehata, NA.[2023]

In a clinical trial involving 110 women undergoing elective cesarean sections, a single dose of carbetocin was found to be effective in maintaining uterine tone and reducing postpartum hemorrhage compared to oxytocin.

Carbetocin not only reduced the need for analgesic medications and postoperative pain significantly on the day of surgery and the following days, but it also improved the overall quality of life for the women in the study.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Carbetocin versus oxytocin after caesarean section: similar efficacy but reduced pain perception in women with high risk of postpartum haemorrhage. De Bonis, M., Torricelli, M., Leoni, L., et al.[2012]

Carbetocin is likely as effective as oxytocin and syntometrine in preventing postpartum hemorrhage, based on a review of various studies that assessed multiple outcome measures.

The safety profile of carbetocin is similar to that of oxytocin, which is currently the standard treatment for this condition, although further research is necessary to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Carbetocin for the prevention of postpartum hemorrhage: a systematic review. Peters, NC., Duvekot, JJ.[2018]

Carbetocin significantly reduces the need for additional uterotonic agents compared to oxytocin in women after cesarean delivery, indicating its efficacy in preventing postpartum hemorrhage.

Carbetocin has a lower risk of adverse effects compared to syntometrine during vaginal delivery, making it a potentially safer alternative for preventing postpartum hemorrhage, with similar effectiveness to other uterotonics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Carbetocin for the prevention of postpartum hemorrhage: a systematic review and meta-analysis of randomized controlled trials. Jin, B., Du, Y., Zhang, F., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Carbetocin versus oxytocin for prevention of postpartum hemorrhage in hypertensive women undergoing elective cesarean section. [2021]

2. Poland pubmed.ncbi.nlm.nih.gov

[Comparison of carbetocin and oxytocin effectiveness for prevention of postpartum hemorrhage after caesarean delivery]. [2019]

3. Germany pubmed.ncbi.nlm.nih.gov

Carbetocin versus oxytocin in the management of atonic post partum haemorrhage (PPH) after vaginal delivery: a randomised controlled trial. [2018]

4. Germany pubmed.ncbi.nlm.nih.gov

Intravenous carbetocin versus intravenous oxytocin for preventing atonic postpartum hemorrhage after normal vaginal delivery in high-risk singleton pregnancies: a triple-blind randomized controlled trial. [2019]

5. England pubmed.ncbi.nlm.nih.gov

Carbetocin versus oxytocin for prevention of postpartum hemorrhage after vaginal delivery in high risk women. [2023]

6. England pubmed.ncbi.nlm.nih.gov

Carbetocin versus oxytocin after caesarean section: similar efficacy but reduced pain perception in women with high risk of postpartum haemorrhage. [2012]

7. United States pubmed.ncbi.nlm.nih.gov

Carbetocin for the prevention of postpartum hemorrhage: a systematic review. [2018]

8. England pubmed.ncbi.nlm.nih.gov

Carbetocin for the prevention of postpartum hemorrhage: a systematic review and meta-analysis of randomized controlled trials. [2022]