Carbetocin reduces the need for additional uterotonics in elective caesarean delivery: a systematic review,meta-analysis and trial sequential analysis of randomised controlled trials |
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| Affiliation: | 1. Department of Anaesthesia, Guy’s & St. Thomas’ NHS Foundation Trust, London, UK;2. Washington University in St. Louis, Missouri, USA;3. Division of Biostatistics, Washington University School of Medicine, Missouri, USA;1. Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt;2. Department of Community Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt;1. Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Canada;2. Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Canada;3. Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Canada;1. School of Medicine, University of Queensland, QLD, Australia;2. Department of Anaesthesia, Sunshine Coast University Hospital, QLD, Australia;3. School of Medicine, University of Wollongong, NSW, Australia;4. Wollongong Hospital, NSW, Australia;5. School of Medicine, University of New South Wales, NSW, Australia;6. Intensive Care Service, Royal Prince Alfred Hospital, NSW, Australia;7. School of Medicine Sydney, University of Notre Dame Australia, NSW, Australia;8. Intensive Care Service, Royal North Shore Hospital, NSW, Australia;1. Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC, USA;2. DebRA Mexico Foundation, Guadalupe NL, Monterrey, Nuevo León, Mexico;3. Department of Neurosciences, University of Padua, Padua, Italy;4. Department of Economics and Statistics, Federico II University of Naples, Monte Sant’Angelo, Naples, Italy;5. Department of Basic Science, Universidad de Monterrey, San Pedro Garza García, Nuevo León, Mexico;6. Department of Stomatology, Cardarelli Hospital, Naples, Italy |
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| Abstract: | BackgroundCarbetocin has been found to be superior to oxytocin in terms of need for additional uterotonics and prevention of postpartum haemorrhage at caesarean delivery. However, this is based on combined data from labouring and non-labouring parturients and it remains unclear how effective carbetocin is in the purely elective setting. The aim of this review was to compare carbetocin to oxytocin in elective caesarean delivery.MethodsMedline, Embase, CINAHL, Web of Science, and the Cochrane databases were searched for randomised controlled trials in any language. The primary outcome was need for additional uterotonics. Secondary outcomes were mean blood loss, need for blood transfusion and incidence of postpartum haemorrhage >1000 mL.ResultsNine studies with a total of 1962 patients were included. Trial sequential analysis confirmed that the information size (n=1692) had surpassed that required (n=1166) in order to demonstrate a statistically significant reduction in the use of additional uterotonics. Need for additional uterotonics was reduced by 53% with carbetocin compared to oxytocin (OR 0.47, 95% CI 0.34 to 0.64; P <0.001, I2=63.5). The number needed-to-treat was 11. The risk of bias, data heterogeneity and inconsistency in reporting bleeding outcomes made it difficult to reach definite conclusions about prevention of PPH.ConclusionsCarbetocin is associated with a reduced need for additional uterotonics when compared with oxytocin at elective caesarean delivery. Standardisation of bleeding-related outcomes in studies is necessary to facilitate synthesis of data in future analyses. |
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| Keywords: | Carbetocin Elective caesarean Postpartum haemorrhage Trial sequential analysis |
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