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Intramuscular oxytocin versus Syntometrine® versus carbetocin for prevention of primary postpartum haemorrhage after vaginal birth: a randomised double-blinded clinical trial of effectiveness, side effects and quality of life

van der Nelson, Helen; O’Brien, Stephen; Burnard, Sara; Mayer, Michelle; Alvarez, Mary; Knowlden, Jade; Winter, Cathy; Dailami, Narges; Marques, Elsa; Burden, Christy; Siassakos, Dimitrios; Draycott, Tim

Intramuscular oxytocin versus Syntometrine® versus carbetocin for prevention of primary postpartum haemorrhage after vaginal birth: a randomised double-blinded clinical trial of effectiveness, side effects and quality of life Thumbnail


Authors

Helen van der Nelson

Stephen O’Brien

Sara Burnard

Michelle Mayer

Mary Alvarez

Jade Knowlden

Cathy Winter

Elsa Marques

Christy Burden

Dimitrios Siassakos

Tim Draycott



Abstract

Objective: To compare intramuscular oxytocin, Syntometrine® and carbetocin for prevention of postpartum haemorrhage after vaginal birth. Design: Randomised double-blinded clinical trial. Setting: Six hospitals in England. Population: A total of 5929 normotensive women having a singleton vaginal birth. Methods: Randomisation when birth was imminent. Main outcome measures: Primary: use of additional uterotonic agents. Secondary: weighed blood loss, transfusion, manual removal of placenta, adverse effects, quality of life. Results: Participants receiving additional uterotonics: 368 (19.5%) oxytocin, 298 (15.6%) Syntometrine and 364 (19.1%) carbetocin. When pairwise comparisons were made: women receiving carbetocin were significantly more likely to receive additional uterotonics than those receiving Syntometrine (odds ratio [OR] 1.28, 95% CI 1.08–1.51, P=0.004); the difference between carbetocin and oxytocin was non-significant (P=0.78); Participants receiving Syntometrine were significantly less likely to receive additional uterotonics than those receiving oxytocin (OR 0.75, 95% CI 0.65–0.91, P=0.002). Non-inferiority between carbetocin and Syntometrine was not shown. Use of Syntometrine reduced non-drug PPH treatments compared with oxytocin (OR 0.64, 95% CI 0.42–0.97) but not carbetocin (P=0.64). Rates of PPH and blood transfusion were not different. Syntometrine was associated with an increase in maternal adverse effects and reduced ability of the mother to bond with her baby. Conclusions: Non-inferiority of carbetocin to Syntometrine was not shown. Carbetocin is not significantly different to oxytocin for use of additional uterotonics. Use of Syntometrine reduced use of additional uterotonics and need for non-drug PPH treatments compared with oxytocin. Increased maternal adverse effects are a disadvantage of Syntometrine. Tweetable abstract: IM carbetocin does not reduce additional uterotonic use compared with IM Syntometrine or oxytocin.

Citation

van der Nelson, H., O’Brien, S., Burnard, S., Mayer, M., Alvarez, M., Knowlden, J., …Draycott, T. (in press). Intramuscular oxytocin versus Syntometrine® versus carbetocin for prevention of primary postpartum haemorrhage after vaginal birth: a randomised double-blinded clinical trial of effectiveness, side effects and quality of life. BJOG: An International Journal of Obstetrics and Gynaecology, 128(7), 1236-1246. https://doi.org/10.1111/1471-0528.16622

Journal Article Type Article
Acceptance Date Dec 3, 2020
Online Publication Date Dec 10, 2020
Deposit Date Jan 12, 2021
Publicly Available Date Mar 29, 2024
Journal BJOG: An International Journal of Obstetrics and Gynaecology
Print ISSN 1470-0328
Electronic ISSN 1471-0528
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 128
Issue 7
Pages 1236-1246
DOI https://doi.org/10.1111/1471-0528.16622
Keywords Obstetrics and Gynaecology; Postpartum haemorrhage; prevention; uterotonic
Public URL https://uwe-repository.worktribe.com/output/6981227

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