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The impact of routine carbetocin use at caesarean section
  1. V Stern,
  2. F Naaisa,
  3. B Strachan
  1. St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK

Abstract

Background Carbetocin is a long-acting oxytocin agonist. Studies suggest it is as effective as oxytocin at preventing postpartum haemorrhage (PPH) and reduces the need for additional uterotonic agents. St Michael's Hospital is a tertiary centre with 5000 deliveries/year. The authors were the first UK unit to use carbetocin at all Caesarean sections and describe our experiences here.

Methods The authors introduced the routine use of carbetocin for all LSCS (lower segment Caesarean section) in May 2009. A retrospective cohort analysis was performed to assess the effect of this. The notes of all 755 patients undergoing LSCS from January–April to June–September were examined. Their weight and pre- and postoperative haematocrit were used to produce calculated blood loss (CBL) results. A sample size calculation demonstrated that the authors would need 250 patients in each arm to show a difference of 250 ml.

Results There was no difference in CBL in the carbetocin group (Student t=−1.0 p=0.37) and their chance of major PPH (>1 L) was not significantly increased with a calculated odds ratio of 1.07 (95% CI 0.76 to 1.5; χ2=0.1).

BeforeAfter
Group size373382
Complete data328 (88%)329 (86%)
% Primips149/373 (40%)166/383 (43%)
Mean CBL726 ml (SD 546)771 ml (SD 584)
CBL ≥1 L92 (28%)97 (29%

Conclusion The routine use of carbetocin has safely been introduced in our unit. It has not increased blood loss at Caesarean section. Further analysis is necessary to assess wider effects of its introduction such as reduced need for syntocinon infusion.

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