Uterotonics in Elective Caesarean Delivery: A Randomised Noninferiority Study Comparing Carbetocin 20 and 100 µg

Abstract

(Anaesthesia. 2019;74:190–196) Postpartum hemorrhage (PPH) is the most common cause of maternal mortality worldwide and accounts for 35% of maternal deaths. Active management of the third stage of labor is recommended in all parturients, with prophylactic uterotonic drug administration after delivery of the infant being the primary component of this active management. This strategy alone has been shown to decrease the incidence of PPH by up to 40%. The 2009 guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC) recommended a single 100 µg intravenous bolus dose of carbetocin as the uterotonic agent of choice, rather than an oxytocin infusion, to prevent PPH after elective cesarean delivery. The rationale for recommending this dose was based on the manufacturer’s recommendation and some clinical trials. Some more recent studies, however, have suggested that doses as low as 15 µg may be effective at preventing PPH after elective cesarean delivery. The current investigators believed a larger trial comparing this smaller dose with the standard 100 µg dose was warranted to confirm these findings. This study was undertaken to compare the uterine tone intensity achieved with 20 carbetocin versus 100 µg carbetocin in women at low risk of PPH undergoing elective cesarean delivery under spinal anesthesia.