A systematic review and meta-analysis of randomized trials comparing carbetocin to oxytocin in prevention of postpartum hemorrhage after cesarean delivery in low-risk women

IF 1.6 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of Obstetrics and Gynaecology Research Pub Date : 2024-12-25 DOI:10.1111/jog.16194

Ahmed M. Maged, Nour A. El-Goly, Doaa Turki, Nehal Bassiouny, Nihal El-Demiry

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引用次数: 0

Abstract

Objectives

To evaluate the efficacy and safety of Carbetocin compared to oxytocin in prevention of postpartum hemorrhage (PPH) after low-risk cesarean delivery (CD).

Search Strategy

Screening of Medline, Web Of Science, Scopus, Google scholar, and clinical trials registry till January 2024 using the key words related to carbetocin, blood loss, PPH, Cesarean section and their MeSH terms was done.

Selection Criteria

This study included all RCTs conducted on women with low risk for developing PPH after CD and compared the administration of carbetocin to oxytocin without any language limitation. These studies compared carbetocin to oxytocin alone or oxytocin combined with misoprostol. The review included all doses and routes of carbetocin and oxytocin administration.

Data Collection and Analysis

The extracted data included study settings, the participants' size and characteristics, intervention details of both the study and control groups especially data about the dose route and timing of drug administration, the outcome parameters and trial registration details The reported outcomes included the requirement of additional uterotonic agents or blood transfusion, the difference between preoperative and postoperative hemoglobin, the occurrence of PPH, blood loss and drug adverse effects.

Main Results

Seventeen studies including 3667 participants were included. The need for additional uterotonic agents was evaluated in 14 studies with 3154 participants and revealed an OR of 0.53 with 95% CI of 0.39 and 0.72 (p < 0.001, I² 41%). The incidence of PPH was reported in 11 studies with 2228 participants and revealed an Odd ratio of 1.08 with 95%CI of [0.81, 1.44] (p = 0.61, I² 0%). The hemoglobin drop after the operation was evaluated in 3 studies with 1240 participants and revealed an MD of −0.08 with 95% CI of −0.10 and − 0.06 (p < 0.001, I² 0%). The need for blood transfusion was evaluated in 9 studies with 1936 participants and revealed an OR of 0.57 with 95% CI of 0.34 and 0.97 (p = 0.04, I² 0%).

Conclusion

Carbetocin administration during CD in women with low risk for PPH is associated with less need for additional uterotonic agents (moderate evidence), less need for blood transfusion (high evidence) and lower hemoglobin drop (high evidence) when compared to those who underwent oxytocin administration without an increase in adverse effects.

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一项比较卡贝菌素和催产素预防低危妇女剖宫产后产后出血的随机试验的系统回顾和荟萃分析。

目的：比较卡贝菌素与催产素预防低危剖宫产（CD）术后产后出血（PPH）的疗效和安全性。检索策略：筛选Medline、Web of Science、Scopus、谷歌scholar、截止2024年1月的临床试验注册表，使用卡霉素、失血、PPH、剖宫产相关关键词及其MeSH术语。选择标准：本研究纳入了所有在CD后发生PPH的低风险妇女中进行的随机对照试验，并比较了卡贝菌素和催产素的使用，没有任何语言限制。这些研究比较了催产素与单独使用催产素或催产素与米索前列醇联合使用。该综述包括卡贝菌素和催产素给药的所有剂量和途径。数据收集和分析：提取的数据包括研究设置、受试者规模和特征、研究组和对照组的干预细节，特别是给药的给药途径和给药时间、结局参数和试验注册细节。报告的结局包括额外使用子宫强张药物或输血的需求、术前和术后血红蛋白的差异、PPH的发生、失血和药物不良反应。主要结果：纳入17项研究，共3667名受试者。在14项3154名参与者的研究中评估了额外子宫扩张药物的需求，结果显示OR为0.53,95% CI为0.39和0.72 （p = 2.41%）。11项研究共报告了2228名参与者的PPH发病率，奇比为1.08,95%CI为[0.81,1.44]（p = 0.61, i2%）。在3项涉及1240名参与者的研究中评估了手术后的血红蛋白下降，结果显示MD为-0.08,95% CI为-0.10和- 0.06 （p < 2%）。9项研究对1936名参与者进行了输血需求评估，结果显示OR为0.57,95% CI为0.34和0.97 （p = 0.04, i2%）。结论：与未增加不良反应的给予催产素的妇女相比，低PPH风险的妇女在CD期间给予卡贝菌素与较少需要额外的子宫扩张药物（中度证据），较少需要输血（高证据）和较低的血红蛋白下降（高证据）相关。

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来源期刊

Journal of Obstetrics and Gynaecology Research 医学-妇产科学

CiteScore

3.10

自引率

0.00%

发文量

376

审稿时长

3-6 weeks

期刊介绍： The Journal of Obstetrics and Gynaecology Research is the official Journal of the Asia and Oceania Federation of Obstetrics and Gynecology and of the Japan Society of Obstetrics and Gynecology, and aims to provide a medium for the publication of articles in the fields of obstetrics and gynecology. The Journal publishes original research articles, case reports, review articles and letters to the editor. The Journal will give publication priority to original research articles over case reports. Accepted papers become the exclusive licence of the Journal. Manuscripts are peer reviewed by at least two referees and/or Associate Editors expert in the field of the submitted paper.