Carbetocin at Elective Cesarean Delivery Part 4

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Abstract

PostPartum hemorrhage (PPH) is a major cause of maternal death worldwide. Oxytocin is the most commonly used uterotonic drug to prevent and treat PPH in North America. However oxytocin has a very short duration of action, requiring a continuous infusion to achieve sustained uterotonic activity. Moreover large doses are associated with adverse effects like hypotension, nausea, vomiting, dysrhythmias and ST changes. The Society of Obstetricians and Gynecologists of Canada (SOGC) has recommended a single dose of 100 mcg of carbetocin at elective cesarean delivery to promote uterine contraction. In three studies recently performed at Mount Sinai Hospital, the investigators have found no difference in uterine contractility between the doses of 20- 120 mcg carbetocin and that the ED90 is 14.8 mcg. Thus a larger trial comparing the minimum effective dose determined in the previous three trials with the standard 100 mcg dose is necessary to confirm these findings.

Description

The current oxytocin regimen requires the administration of a continuous infusion to achieve sustained uterotonic activity, which can be associated with a number of side effects and unpredictable efficacy. Carbetocin in a single 100 mcg dose has apparently greater efficacy, with a similar side effect profile to that of oxytocin. In addition, some studies have also shown that there is less blood loss and less requirement for additional uterotonic drugs when carbetocin is administered. Studies conducted by the investigators group at Mount Sinai have shown similar efficacy between the doses ranging from 20 to 100 mcg of carbetocin. In the investigators study, the investigators are going to compare those two doses of carbetocin to determine that 20 mcg is not inferior to 100 mcg to produce adequate uterine tone in elective cesarean delivery. This study will be a randomized, double - blind, non inferiority study.

Dates

Last Verified:	04/30/2015
First Submitted:	10/08/2014
Estimated Enrollment Submitted:	10/13/2014
First Posted:	10/14/2014
Last Update Submitted:	05/21/2015
Last Update Posted:	05/26/2015
Actual Study Start Date:	09/30/2014
Estimated Primary Completion Date:	03/31/2015
Estimated Study Completion Date:	04/30/2015

Condition or disease

Postpartum Hemorrhage

Intervention/treatment

Drug: Carbetocin

Phase

Arm Groups

Arm	Intervention/treatment
Active Comparator: Carbetocin 20mcg Patient is given carbetocin 20 mcg intravenously over 1 minute, immediately upon delivery of the anterior shoulder of the baby.
Active Comparator: Carbetocin 100mcg Patient is given carbetocin 100 mcg intravenously over 1 minute, immediately upon delivery of the anterior shoulder of the baby.

Eligibility Criteria

Ages Eligible for Study	18 Years To 18 Years
Sexes Eligible for Study	Female
Accepts Healthy Volunteers	Yes
Criteria	Inclusion Criteria: - Elective cesarean delivery under spinal anesthesia. - Written informed consent to participate in this study. - Term pregnancy Exclusion Criteria: - Refusal to give written informed consent. - Allergy or hypersensitivity to carbetocin or oxytocin. - Conditions that predispose to uterine atony and postpartum hemorrhage, such as placenta previa, multiple gestation, preeclampsia, eclampsia, macrosomia, polyhydramnios, uterine fibroids, previous history of uterine atony and postpartum bleeding, or bleeding diathesis. - Hepatic, renal, and vascular disease.

Outcome

Primary Outcome Measures

1. Uterine tone [2 minutes]

Uterine tone on a scale of 0-10 at 2 minutes after completion of injection of carbetocin.

Secondary Outcome Measures

1. Uterine tone [5 minutes]

Uterine tone on a scale of 0-10 at 5 minutes after completion of injection of carbetocin.

2. Additional uterotonic medication administration [24 hours]

2. The use of additional uterotonic at any time post administration of carbetocin up to 24 hours post delivery.

3. Blood loss [48 hours]

Blood loss will be calculated through the difference in hematocrit values assessed prior to and at the end of 48 hours after the cesarean section.

4. Side Effects [2 hours]

Any of the following will be noted up to 2 hours post delivery: systolic blood pressure < 80% of pre-delivery values, tachycardia > 30% pre-delivery levels, bradycardia < 30% pre-delivery levels, other dysrhythmias, nausea, vomiting, chest pain, shortness of breath, headache, flushing, others

Carbetocin at Elective Cesarean Delivery Part 4

Keywords

nausea

vomiting

hemorrhage

hypotension

postpartum hemorrhage