The Use of Carbetocin in Patients Undergoing Elective Cesarean Section

Abstract

1-Background: Primary post-partum hemorrhage (PPH) is defined as blood loss greater than or equal to 500 ml within 24 hours after birth, while severe PPH is blood loss greater than or equal to 1000 ml within 24 hours. According to the national statistics in Egypt, hemorrhage before and after delivery was the leading direct cause of maternal death (43%), with most hemorrhage deaths due to postpartum hemorrhage. There were 32 maternal deaths with hemorrhage per 100,000 live births. Figures for other causes were much less than hemorrhage (e.g. hypertensive diseases were 18 per 100,000, for sepsis 7 per 100,000, for ruptured uterus 7 per 100,000, for cesarean section 6 per 100,000, for obstructed labor 4 per 100,000, for cardiac disease 11 per 100,000 and for anemia 9 per 100,000). 2- Rationale: Active management of the third stage of labour has three components - use of uterotonic agents, early cord clamping and controlled cord traction. The administration of uterotonic drugs widely prevents the PPH, significantly decreases the incidence of PPH and therefore it is the main component of active management. Although the oxytocin is the most widely accepted uterotonic agent, however other drugs are available, but which agent is ideal for prophylactic use is far to be clearly stated.