Carbetocin Use during Caesarean Deliveries in Preventing Postpartum Haemorrhage (PPH) In Enugu: A 15-Case Series and Review of Literature

Abstract

Background: The news of pregnancy is usually a happy one in a family and the birth of a new baby marks the peak of the experience. However, many times this happy beginning is clouded by pain and sorrow when serious maternal morbidity or mortality occurs. The major cause of maternal death is Primary postpartum haemorrhage. The introduction of active management of the third stage of labour has significantly reduced the incidence of maternal mortality but the risk of PPH is not entirely eliminated, hence, the need for a near ideal uterotonic agent that will better prevent or control PPH. Carbetocin promises to be a veritable tool in this regard and this case series was designed to showcase our experience with the drug. Aim: The aim was to analyze our experiences with Carbetocin during caesarean section in preventing PPH. Methodology: This was a case series of 15 women who had caesarean delivery in 3 different hospitals in Enugu under cover of Carbetocin. An extensive literature search was also done to unravel the extent of use and reported efficacy or otherwise of Carbetocin compared with our own experience. Relevant data was collated using a proforma and the result was analyzed using SPSS version 25.0 Results: The result from the study showed that out of the fifteen subjects analyzed, 5(33.3%) were less than 30 years while 10(66.7%) were more than 30 years and that 14(93.3%) of them were Igbo, whereas only 1(6.7%) was Yoruba. Seven of them (46.7%) were primipara, 1(6.7%) was para-4 or more and the rest were either between para-2 or para-3. Intra-operatively 12(80%) had no uterine fibroid and 3(20%) had one or more uterine fibroids. It also revealed that 6(40%) were delivered at a gestational age of 38 weeks, 3(20%) at 37 weeks and 1(6.7%) each at 35 weeks and 40 weeks. Only 1(6.7%) had need for additional uterotonics whereas the remaining 14(93.3%) had no need for additional uterotonics during and after the surgery. There was no record of any side-effects in any of the subjects. Prolonged labour and placenta previa with previous caesarean delivery topped the list of indications each having 3(20%) whereas breech presentation and previous caesarean deliveries were 2(13.3%) each; the others constituted the remaining 5(33.3%) each. The mean estimated blood loss was 335.33ml±140.80 (p-value= 0.001 and CI= 4.68-8.26), the average pre-operative packed cell volume (PCV), 34.2%±2.73 whereas the mean post-operative PCV was 30.93%±2.21(p-value = 0.001 and CI= 2.55-3.90). There were no side-effects recorded in any of the subjects. Conclusion: Carbetocin is an efficacious uterotonic agent and is very effective in preventing uterine atony and PPH during caesarean deliveries with minimal and tolerable side-effects.