Postpartum blood loss with and without use of prophylactic carbetocin during .. Carbetocin versus oxytocin for the prevention of postpartum haemorrhage. Postpartum haemorrhage (PPH) is the leading cause of maternal mortality Carbetocin may be an underused uterotonic for prevention of PPH. Postpartum haemorrhage (PPH) is defined as blood loss of ml or more within carbetocin versus prostaglandins for the prevention of PPH were reviewed.

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Among the adverse outcomes rated as important, a higher rate of vomiting RR 3. Active management of third stage of labour Education material for teachers of midwifery. This review of ten randomized haemprrhage trials women provided evidence related to the effect of misoprostol on the management of PPH. Medical eligibility criteria for contraceptive use. GDG members discussed the balance between desirable and undesirable effects, overall quality of supporting evidence, values and preferences of stakeholders, resource requirements, cost-effectiveness, acceptability, feasibility and equity, to finalize the recommendation and remarks.

The incidence of uaemorrhage hypertension was also significantly lower in women who received carbetocin compared to those who received hhaemorrhage. Of the reported critical outcomes, there was no difference in the need for blood transfusion between the groups, or for the manual removal of the placenta.

Doses of oxytocin used ranged from 2 IU to 10 IU, while the fixed drug combination doses consisted of 5 IU of oxytocin and 0. Use of carbetocin resulted in a statistically significant reduction in the need for therapeutic uterotonics risk ratio RR 0.

Related links WHO recommendations on prevention and treatment of postpartum haemorrhage – full document and evidence tables Managing Complications in Pregnancy and Childbirth: There was no statistically significant difference between the two groups with regard to blood loss, the use of blood transfusion, or the use of additional uterotonics.


Oxytocin agonists for preventing postpartum haemorrhage. Two studies reported a statistically significant lower use of additional uterotonics in the group receiving the fixed dose oxytocin-ergometrine combination RR 0.

Further information on evidence supporting this recommendation are available here. Mousa HA, Alfirevic Z. Evidence related to the use of various uterotonics was extrapolated from research on the prevention of PPH.

Carbetocin for preventing postpartum haemorrhage.

This document is part of the process for improving the quality of care in family planning. Education material for teachers of midwifery. Systematic reviews comparing the effects of oxytocin versus ergometrine, a fixed dose combination of oxytocin versus ergometrine, and pistpartum versus prostaglandins for the prevention of PPH were reviewed.

Update of Cochrane Database Syst Rev.

After an uncomplicated vaginal birth in a health care facility, healthy mothers and newborns should receive care in the facility for at least 24 hours after birth. This video provides an overview of performance of catheterization of the bladder.

Prophylactic ergometrine-oxytocin versus other uterotonics for active management of the third stage of labour. One Cochrane systematic review was conducted to assess the effectiveness and safety of any intervention used for the treatment of primary PPH. Of the 60 patients in the group receiving IM prostaglandin, two required the use of additional uterotonics, compared to 10 of the 60 patients who received rectal misoprostol RR 0. Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage.

Including this trial in the meta-analysis changes the results RR 0. Rating the quality of evidence. Skip to main content. Implementation considerations The successful introduction fkr evidence-based policies related to the prevention and management of PPH into national programmes and health postpatum services depends on well-planned and participatory consensus-driven processes of adaptation and implementation.

One Cochrane systematic review investigated the effects of prophylactic oxytocin versus placebo or prevsnting treatment versus ergot alkaloids:.

The recommendation should be adapted into locally-appropriate documents and tools that are able to meet the specific needs of each country and health service. WHO recommendation on postpartym postpartum maternal assessment.


It includes recommendations for iron supplementation in countries where malaria is prevalent A guide for midwives and doctors. World Health Organization, We checked references of articles and communicated with authors and pharmaceutical industry contacts.

There is no added benefit to offering misoprostol simultaneously to women receiving oxytocin for the treatment of PPH i. WHO recommendations on interventions to improve preterm birth outcomes. There was no observed difference reported in high blood pressure in women treated with oxytocin only RR 0.

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This group of independent experts used the evidence profiles to assess evidence on effects on the pre-specified outcomes. Syntometrine is more effective than oxytocin but is associated with more side effects. Decisions in such situations must be guided by the experience of the provider, the availability of the drugs, and by known contraindications.

Updated planned for early Assessed as up-to-date: Two review authors independently assessed trials for inclusion, assessed risk of bias and extracted data. There was no statistically significant difference in terms of the need for therapeutic uterotonic agents, but the risk of adverse effects such as nausea and vomiting were significantly lower in the carbetocin group: Treatment for primary postpartum haemorrhage.

PPH is the primary cause of nearly one-fifth of all maternal deaths globally.

Carbetocin versus oxytocin Evidence came from one systematic review of 11 trials women which evaluated the effect of carbetocin mcg as an IV bolus or IM injection for the prevention of PPH after vaginal delivery and caesarean section versus oxytocin, fixed dose oxytocin-ergometrine, and placebo.