Carbetocin vs oxytocin in third stage labour: a quantitative review of low- and middle-income countries
Postpartum haemorrhage is a global concern and is a leading cause of maternal mortality in low- and middle-income countries. Oxytocin is the preferred prophylactic uterotonic; however, it is heat sensitive and therefore may not be suitable in low- and middle-income countries, which are often warm climates. An alternative is carbetocin, which is heat stable and longer acting.
Literature was sourced from the EBSCO, CINAHL, Medline and Global Health databases. Studies written in English in the last 10 years, that compared carbetocin to oxytocin in management of postpartum haemorrhage were selected. An ABCDFIX mnemonic tool was used to individually critique each study.
The key themes were postpartum haemorrhage over 500ml, postpartum haemorrhage over 1000ml, need for blood transfusion, retained placenta, haemoglobin levels and need for additional uterotonics. The use of carbetocin may reduce the risk of postpartum haemorrhage and the need for additional uterotonics in low- and middle-income countries.
The use of carbetocin, instead of oxytocin, in low- and middle-income countries may reduce the risk of postpartum haemorrhage after vaginal birth and the need for more uterotonics. However, more research is needed in these settings.
Postpartum haemorrhage is defined as blood loss of over 500ml from the genital tract in the first 24 hours of a baby's birth (Mavrides et al, 2016). It is a current global health concern, as it is a major cause of maternal mortality in low- and middle-income countries (World Health Organization (WHO), 2022). The sustainable development goals seek to decrease the global maternal mortality rate to under 70 per 100 000 live births by 2030, yet in 2017, the maternal mortality rates in low-income countries were 434.7 per 100000 (Sachs et al, 2021). The WHO (2022) states that, each year, postpartum haemorrhage occurs in 14 million women, leading to an estimated 70 000 maternal mortalities globally. Women in low- and middle-income countries are disproportionately affected by postpartum haemorrhage and the associated risk of morbidity and mortality, as it is estimated that 80% of maternal deaths from postpartum haemorrhage occur in sub-Saharan Africa and south Asia (WHO, 2023).
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