Efficacy of carbetocin in the prevention of postpartum hemorrhage: a systematic review and Bayesian meta-analysis of randomized trials

Gokce, Ali
O'Brien, Pat
Benlioglu, Can
Koc, Acar
Karaaslan, Onur
Khalil, Asma
Objectives: To evaluate the efficacy of carbetocin for the prevention of postpartum hemorrhage (PPH) and related events after vaginal or cesarean delivery. Methods: Medline, Scopus, Embase, and the Cochrane Library were searched in February 2018 using combinations of the relevant MeSH terms, keywords. Randomized studies, comparing carbetocin to any other uterotonic agent, in the management of cesarean and vaginal deliveries, were conducted. Two reviewers independently extracted the data. A random-effects meta-analysis was used for quantitative synthesis. Also, Bayesian random-effect metaregression was used to estimate the posterior probabilities (PP) for benefits of carbetocin use. Results: After the full-text review, 30 trials were included in the meta-analysis. Compared to oxytocin, carbetocin was associated with a reduced need for additional uterotonic use in women undergoing cesarean delivery (RR 0.43, 95% CI 0.30-0.59, I-2 = 71%, 3216 women, PP > 99.9%). Women at high risk of PPH delivering vaginally also had a reduced need for additional uterotonic use with carbetocin compared to oxytocin (RR 0.56, 95% CI 0.34-0.94, I-2 = 38%, 789 women, PP = 81.2%). The risk of postpartum blood transfusion (RR 0.57, 95% CI 0.33-0.96, I-2 = 0%, 1991 women, PP = 97.9%) was also less with carbetocin compared to oxytocin in high-risk women undergoing cesarean delivery. The risk of PPH was similar between carbetocin and other uterotonic agents for both cesarean (RR 0.69, 95% CI 0.45-1.05, I-2 = 27%, 2926 women, PP = 96.3%) and vaginal deliveries (RR 0.61, 95% CI 0.32-1.14, I-2 = 35%, 1515 women, PP = 88.9%). Conclusions: Carbetocin is effective in reducing the need for additional uterotonic use and postpartum blood transfusion in women at increased risk of PPH undergoing cesarean delivery. There is still a need for high-quality trials on its effectiveness in preventing PPH in high-risk women. Precis Carbetocin is effective in reducing the need for additional uterotonic use and postpartum blood transfusion in high-risk women undergoing Cesarean delivery.


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Objective: To assess whether assessment with ultrasound could improve the detection of emergency cesarean section (ECS) in laboring women. Methods: Women who presented with symptoms of active labor or women in need of labor induction were invited to participate in the study. Women included in the study were evaluated with ultrasonography for fetal biometry and vaginal examinations for Bishop score assessment. The main aim in this study was determining factors associated with ECS due to fetal distress and ob...
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Objective: Small for gestational age (SGA) fetuses are at increased risk of admission to the neonatal unit, even at term. We aimed to develop and validate a predictive model for the risk of prolonged neonatal unit admission in suspected SGA fetuses at term. Methods: A single-center cohort study of singleton pregnancies with SGA fetus, defined as estimated fetal weight (EFW) less than the 10th centile, at term. The variables included known risk factors for neonatal unit admissions: maternal characteristics, ...
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Objective The use of aspirin in twin pregnancies for the prevention of preeclampsia is a controversial topic, and evidence on the required dose of aspirin is scarce. We aimed to assess the efficacy of 75 mg/day vs 150 mg/day aspirin for the prevention of preeclampsia in twin pregnancies. Study Design This is a retrospective cohort study of twin pregnancies managed at St George’s University Hospital between 2012 and 2019. The National Institute for Health and Care Excellence guideline published in 2010 has...
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Background Women with a history of hypertensive disorders of pregnancy (HDP) are at increased long-term risk of cardiovascular disease. However, there has been increasing evidence on the same risks in the months following birth. Objectives This review aims to estimate the incidence of hypertension in the first 2 years after HDP. Search strategy MEDLINE, Embase and Cochrane databases were systematically searched in October 2019. Selection criteria Observational studies comparing hypertension rate following H...
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Objective: The aim of this study was to evaluate the efficacy of citalopram for climacteric symptoms and to assess the combined effect of citalopram and hormone therapy (HT) on climacteric symptoms in women inadequately responsive to HT alone.
Citation Formats
E. KALAFAT et al., “Efficacy of carbetocin in the prevention of postpartum hemorrhage: a systematic review and Bayesian meta-analysis of randomized trials,” JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE, pp. 0–0, 2019, Accessed: 00, 2020. [Online]. Available: https://hdl.handle.net/11511/68441.