Carbetocin: a therapy advance for prevention of postpartum haemorrhage
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20221604Keywords:
Uterine atony, PPH, UterotonicAbstract
Postpartum haemorrhage (PPH) is the major cause of maternal death. To prevent PPH, the routine administration of a uterus-contracting (‘uterotonic’) agent is a standard practice across the world. Oxytocin is the standard uterotonic agent recommended for this purpose, and is recommended for all women giving birth. Oxytocin is problematic as it requires cold storage and transport, and in low-resource settings, the cold chain is not commonly available. Heat-stable carbetocin is a promising alternative to oxytocin. Because of its heat stability, it can overcome the persistent problems with oxytocin quality as it does not require cold chain for storage and transport. Considering the totality of the evidence, it appears to have some additional desirable effects compared with oxytocin and a very favourable side effect profile similar to oxytocin. With a standardized dosing of single injection recommendation, it can address the variations in dosing regimen as is with oxytocin. Carbetocin has been added to the World Health Organization (WHO) essential medicines list of uterotonics for the prevention of excessive bleeding after childbirth, we might see a new standard of care in coming months for prevention of uterine atony.
References
Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, Gülmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323-33.
Anderson JM, Etches D. Prevention and management of postpartum haemorrhage. Am Fam Physician. 2007;75:875-82.
Su LL, Chong YS, Samuel M. Carbetocin for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2012;(4):CD005457.
World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. 2012. Available at: https://apps.who.int/ iris/bitstream/handle/10665/75411/9789241548502_eng.pdf. Accessed on 05 January 2022.
Fahmy NG, Yousef HM, Zaki HV. Comparative study between effect of carbetocin and oxytocin on isofluraneinduced uterine hypotonia in twin pregnancy patients undergoing cesarean section. Egypt J Anaesth. 2016;32:117-21.
Chong YS, Su LL, Arulkumaran S. Current strategies for the prevention of postpartum haemorrhage in the third stage of labour. Curr Opin Obstet Gynecol. 2004;16:143-50.
Hogerzeil HV, GJA W, de Goeje MJ. Stability of injectable oxytocics in tropical climates: WHO report; 1993. WHO/AP93.6. Available at: http://apps.who. int/iris/handle/10665/59411. Accessed on 05 January 2022.
Mullany L, Newton S, Afari-Asiedu S. Cumulative effects of heat exposure and storage conditions of oxytocin-in-Uniject in rural Ghana: implications for scale up. Global Health Sci Pract. 2014;2(3):285-94.
WHO Quality of misoprostol products. WHO Drug Inf. 2016;30:35.
Malm M, Madsen I, Kjellström J. Development and stability of a heat-stable formulation of carbetocin for the prevention of postpartum haemorrhage for use in low and middle-income countries. J Pept Sci. 2018;24(6):e3082.
American College of Physicians. Practice strategies for elective red blood cell transfusion. Ann Intern Med. 1992;116:403-6.
Atke A, Vilhardt H. Uterotonic activity and myometrial receptor affinity of 1-deamino-1-carba-2-tyrosine(O-methyl)-oxytocin. Acta Endocrinol (Copenh). 1987;115:155-60.
Pabal. Product information. Available at: Pabal 100 micrograms in 1ml solution for injection - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk). Accessed on 16 April 2022.
Widmer M, Piaggio G, Nguyen TMH, Osoti A, Owa OO, Misra S, et al. WHO CHAMPION Trial Group. Heat-Stable Carbetocin versus Oxytocin to Prevent Hemorrhage after Vaginal Birth. N Engl J Med. 2018;379(8):743-52.
Tse KY, Yu FNY, Leung KY. Comparison of carbetocin and oxytocin infusions in reducing the requirement for additional uterotonics or procedures in women at increased risk of postpartum haemorrhage after Caesarean section. Hong Kong Med J. 2020;26(5):382-9.
Gallos ID, Williams HM, Price MJ, Merriel A, Gee H, Lissauer D, et al. Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. Cochrane Database Syst Rev. 2018;4(4):CD011689.
World Health Organization. WHO recommendations on prevention and treatment of postpartum haemorrhage. 2012. Available at: https://apps.who.int/ iris/bitstream/handle/10665/75411/9789241548502_eng.pdf. Accessed on 16 April 2022.
World Health Organization. WHO recommendations: Uterotonics for the prevention of postpartum haemorrhage. Available at: https://apps.who.int/iris/ bitstream/handle/10665/277276/9789241550420-eng.pdf?ua=1. Accessed on 16 April 2022.
Malm M, Madsen I, Kjellström J. Development and stability of a heat-stable formulation of carbetocin for the prevention of postpartum haemorrhage for use in low and middle-income countries. J Pept Sci. 2018;24(6):e3082.
