Does carbetocin for prevention of postpartum haemorrhage at caesarean section provide clinical or financial benefit compared with oxytocin?

Abstract

Postpartum haemorrhage is a major cause of maternal morbidity and mortality worldwide. A recent Cochrane review of carbetocin (long-acting oxytocin analogue) concluded that its use decreased additional uterotonic requirements, however, no included studies compared its use against intravenous bolus oxytocin. The majority of studies of carbetocin have considered its use in vaginal delivery; no studies have examined the economic implications of its use. This study describes a clinical and financial evaluation undertaken at a United Kingdom District General Hospital surrounding the introduction of carbetocin for prophylaxis against postpartum haemorrhage at caesarean deliveries. A range of clinical outcomes were observed including frequency of postpartum haemorrhage, estimated blood loss, transfusion requirements, change in haemoglobin or haemodynamics, use of additional uterotonics and perioperative recovery. Finally, a composite financial analysis was performed. No clinically significant benefit was found, however associated costs increased by £18.52/patient.

Keywords::

• Caesarean section
• carbetocin
• oxytocin
• postpartum haemorrhage
• service evaluation

Acknowledgements

The authors would like to thank Janet Cooper (IT Midwife, Royal Bolton Hospital), Rebecca Walker (Women's Health Pharmacist, Royal Bolton Hospital) and the staff of the Clinical Effectiveness Department, Medical Records Department and Drugs and Therapeutics Committee at the Royal Bolton Hospital for their assistance in this study.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. Funding for obtaining of notes for the retrospective matched patients was received from Ferring, UK. LH performed data collection, statistical analyses and prepared the manuscript and declares no further conflict of interest in these tasks. JM assisted in data collection and review of the manuscript and declares no further conflict of interest. AJT designed the study, assisted in data collection and review of the manuscript.

Appendix 1. Delivery Data Collection Proforma

Delivery Data Collection Proforma

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Operative details:

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Time interval between delivery and oxytocic intervention: ……… min

Surgical procedure undertaken to control haemorrhage:

Estimated blood loss ___ml

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Recovery room:

Time spent in recovery room (h):

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Type of feeding at discharge: Br / Bot / Mix

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Time course of admission (low risk elective deliveries).

Uterine tone (low risk elective deliveries).

Side-effects (low risk elective deliveries).

Analgesia and antiemetic requirements (low risk elective deliveries).

Skin-to-skin contact, time and method of feeding (low risk elective deliveries).