Hemodynamic Changes in Women with Severe Preeclampsia Following Administration of Carbetocin, Oxytocin or Misoprostol for Prevention of Atonic Postpartum Hemorrhage during Cesarean Section "A Randomized Controlled Trial"

Abstract

C esarean deliveries are performed for a variety of fetal and maternal indications. The indications have been expanded to consider the patient’s wishes and preferences. Increases in the rate cesarean sections with no specified indication appear to be the result of changes in obstetric practice rather than changes in the medical risk profile or increases in maternal request. Postpartum hemorrhage is the leading cause of maternal deaths worldwide. The majority of these deaths occur within 4 hours of delivery, which indicates that they are a consequence of the third stage of labour. The risk of postpartum hemorrhage is much higher for women undergoing cesarean section than normal vaginal labor, particularly in developing countries where the majority of operations are carried out as an emergency procedure. In most cases, uterine atony is responsible for the occurrence of excessive bleeding during or following childbirth. Active management of third stage of labor, particularly the prophylactic use of uterotonic agents can significantly decrease the incidence of postpartum hemorrhage compared with that of expectant management. Oxytocin is the most widely used uterotonic agent, but it has a relatively short half-life. Carbetocin is a long-acting synthetic analogue of oxytocin, that can be administered as a single-dose injection, either intravenously or intramuscularly. Intravenously administered carbetocin has a half-life of approximately around 4–10 times longer than that reported for oxytocin.