Studying Different Protocols for Prevention of Atonic Postpartum Hemorrhage during Cesarean Delivery in High Risk Group

Abstract

Background: Various medications and techniques can be used to prevent atonic postpartum hemorrhage (PPH) during Cesarean  delivery in high risk women, but optimal protocols remain unclear.

Objective: This work aimed to determine the most effective pharmacological agent for preventing postpartum hemorrhage during  Cesarean delivery, while minimizing adverse side effects, particularly in females with a greater risk of atonic PPH.

Methods: This  randomized double-blind active controlled trial was carried out on pregnant full term > 37 weeks women of high risk  group. Patients were divided into four groups: Group 1 (n = 125) who received oxytocin only 20 IU by IV drip over 15- 60 min, group 2 (n =  125) who received oxytocin 20 IU by IV drip over 15- 60 min + misoprostol 600 micrograms orally, group 3 (n = 125) who received  carbetocin 100 microgram intravenous in slow rate over one minute, and group 4 (n = 125) who received carbetocin 100 microgram  intravenous in slow rate over one minute + misoprostol 600 microgram orally. 

Results: Patients who received oxytocin only had a 1.59  higher risk of uterine atony when compared to those who received carbetocin only (95% CI = 1.12 – 2.11, p = 0.001). Meanwhile, patients  who did not receive misoprostol had a 1.48 higher risk of uterine atony when compared to those who received misoprostol (95% CI = 1.18  – 1.86, p = 0.001). The incidence of blood transfusion, transfused blood units, intra-operative blood loss, 24-hour estimated postoperative  blood loss and total blood loss exhibited a significant difference among the groups (p = 0.020*) with the carbetocin + misoprostol group  has the highest values compared to the other groups. 

Conclusions: Carbetocin stands out as a reliable uterotonic agent in Cesarean  sections, providing effective prevention of postpartum hemorrhage with a favorable side effect profile. Its combination with misoprostol  demonstrated promising outcomes, emphasizing its potential for optimizing obstetric care during Cesarean deliveries.