Effects of Stepwise Carbetocin Administration on Postpartum Hemorrhage after Prelabor Cesarean Delivery
DOI:
https://doi.org/10.33192/smj.v77i7.273108Keywords:
Carbetocin, stepwise administration, cesarean delivery, postpartum hemorrhageAbstract
Objective: To evaluate the effectiveness of stepwise administration of carbetocin in reducing postpartum hemorrhage (PPH) in term pregnancies undergoing elective cesarean delivery.
Materials and Methods: This study included term pregnancies scheduled for cesarean delivery. Exclusion criteria were a BMI ≥ 35 kg/m2, any underlying disease contraindicated carbetocin use, and conditions affecting uterine contraction. Following newborn delivery, an initial dose of 50 µg of carbetocin was administered, with a subsequent 50 µg given if uterine contraction was inadequate. The primary outcome was the incidence of PPH exceeding 500 mL, while secondary outcomes included total blood loss ≥ 1,000 mL, administration of additional uterotonic agents, adverse effects, other pregnancy-related and surgical outcomes.
Results: Out of 152 pregnant women analyzed, adequate uterine contraction was observed in 69.7% of cases after the first carbetocin dose, with an additional 19.7% achieving adequate contraction after the second dose. Estimated blood loss exceeded 500 mL was 32.9% and exceeded 1,000 mL was 2.0% of cases, respectively. Recalculations based on pre- and post-hematocrit levels indicated higher rates of blood loss: more than 500 mL in 45.4% and over 1,000 mL in 13.8%. No serious side effects or complications were reported.
Conclusion: The stepwise regimen demonstrated an effectiveness of 69.7% in preventing postpartum hemorrhage (PPH) during elective cesarean deliveries with the initial 50 µg dose, which increased to 89.4% following the administration of a second dose.
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