Carbetocin for Elective Caesarean Delivery:
Impact on Use of Second-line Uterotonics
•Current NICE guidance recommends the use of 5 international units of oxytocin by slow IV bolus immediately following caesarean delivery.1
•Carbetocin is a long-acting synthetic analogue of oxytocin.
•Use of carbetocin has been shown to reduce the need for further uterotonics as compared with oxytocin, for caesarean delivery.2
•Carbetocin was introduced as part of a local enhanced recovery programme for elective caesarean delivery in March 2015.
•This audit aimed to evaluate the impact of the use of carbetocin for elective caesarean delivery on the use of second-line uterotonics and the estimated blood loss (EBL).
•The audit was registered with the local audit committee as a service evaluation exercise.
•All elective caesarean deliveries performed between May 2013 and November 2015, were identified using an electronic database (Euroking©).
•Patients were grouped according to first-line uterotonic used; either intravenous oxytocin 5IU or intravenous carbetocin 100mcg.
•Primary outcome measured was use of second-line uterotonics.
•Secondary outcome measured was EBL.
•Data were collected on 1030 patients of which 889 was complete data ; Carbetocin group = 425, Oxytocin group = 464
•The use of second-line uterotonics was higher in oxytocin group as compared to the carbetocin group
•17.5% vs 4.7% ; RR 3.72
•There was no significant difference in EBL observed between the two groups
•570 ± 257ml vs 590 ± 303ml; p=0.3
•Carbetocin, given as a first-line treatment in elective caesarean delivery, is associated with a reduction in the need for second-line uterotonics.
•There was no difference in EBL between the two groups.
•The increased cost of using carbetocin needs to be counterbalanced against the reduced exposure to additional uterotonics and their side effects if using oxytocin only.
1.NICE Guidelines [GC132]. Caesarean Section. National Institute for Health and Clinical Excellence 2011.
2.Su L-L, Chong Y-S, Samuel M. Carbetocin for preventing postpartum haemorrhage. Cochrane database of Systematic Reviews 2012, Issue 4. Art. No.: CD005457