Carbetocin versus syntometrine in the management of third stage of labor following vaginal delivery

Abstract

Objective: To assess and compare the efficacy and safety of a single intramuscular dose of carbetocin to a single intramuscular dose of syntometrine in managing the third stage of labor following vaginal delivery among women with low risk factors for postpartum hemorrhage.

Study design: Prospective double-blind randomized controlled study.

Subjects and methods: The study included 240 healthy women with viable normal singleton pregnancies achieving normal vaginal delivery at or beyond 37 weeks' gestation during the period from May 2009 to December 2009 at TAIBA Hospital in Kuwait. Women were randomized to receive either a single dose of carbetocin or syntometrine intramuscularly following the delivery of the anterior shoulder of the baby. Outcome measures compared included postpartum hemorrhage requiring additional uterotonic therapy, incidence of postpartum hemorrhage, amount of intrapartum blood loss as well as adverse effects profile.

Results: There was a statistically highly significant difference in the estimated mean blood loss between the carbetocin and syntometrine groups, with a blood loss of 81.5 ml higher in the syntometrine group. The mean drop of hemoglobin concentration 24 h after delivery was 0.8 g/dl in carbetocin group and 1.1 g/dl in syntometrine group, and the difference was statistically highly significant. Women in the carbetocin group were less likely to experience nausea and vomiting.

Conclusion: Single dose of intramuscular carbetocin 100 μg may be more effective as compared to a single intramuscular dose of syntometrine in reducing postpartum blood loss with a smaller drop in hemoglobin levels and less adverse effects.