Comparison of carbetocin with other uterotonic agents in preventing postpartum hemorrhage

Postpartum hemorrhage (PPH) is defined as blood loss of at least 500 ml or more after vaginal delivery and 1000 ml or more after abdominal delivery. It contributes up to 28% of maternal mortality worldwide and 30.3% of maternal death in Indonesia. 70% cases of PPH are caused by uterine atony. PPH can be prevented by doing routine use of uterotonic agents in active management of third stage of labour. Uterotonic agents that currently available are oxytocin, carbetocin, methylergometrine, syntometrine, misoprostol and carboprost. Carbetocin (a long-acting synthetic analogue of oxytocin) is a new drug which has stronger ability to induce uterine contraction than oxytocin. It does not induce hypertension like methylergometrine and syntometrine. Therefore, carbetocin can be considered as an alternative drug to oxytocin in women with severe preeclampsia. However, more studies are needed to assess the efficacy and safety of carbetocin for prevention of PPH in preeclamptic women. Compared to methylergometrine and syntometrine, carbetocin is more effective in reducing postpartum blood loss. Adverse effects like nausea and vomiting were lower in women treated with carbetocin. Compared to misoprostol, carbetocin is also superior in reducing blood loss. Adverse effects like shivering, fever and metallic taste were higher in women treated with misoprostol. Further studies are needed to assess the superiority between carbetocin and carboprost since there is no published literature yet regarding this topic. In conclusion, carbetocin is superior to other uterotonic agents in preventing postpartum hemorrhage with fewer adverse effects