Uso de carbetocina frente al uso de oxitocina en pacientes intervenidas por cesárea con alto riesgo de atonía uterina / Use of Carbetocin versus Oxytocin in Cesareans with High Risk of Uterine Atony

Introducción: la utilización adecuada de medicamentos uterotónicos es fundamental en el manejo de la hemorragia obstétrica. Objetivo: describir los efectos de la carbetocina y su comparación con la oxitocina como primera elección para prevenir la hemorragia obstétrica en pacientes cesareadas con riesgo de atonía uterina. Métodos: se realizó un estudio prospectivo, comparativo y transversal, en el 2016, donde se incluyeron 165 pacientes embarazadas que ingresaron para interrupción del embarazo por cesárea, las cuales tenían factores de riesgo de atonía uterina. Se formaron dos grupos: el A, con 110 pacientes que recibieron oxitocina a dosis de 10 U por vía intravenosa, y el B, con 55 pacientes a las que se les administraron 100 mg de carbetocina después del nacimiento. Resultados: ambos grupos resultaron similares en la edad. En el grupo A, el promedio de edad fue de 27,5 años, y en el B, de 28,1 años. Se encontró una adecuada contractilidad en 83 pacientes del grupo A (75,45 por ciento) y en 53 del grupo B (96,36 por ciento). El grupo que recibió carbetocina requirió menor cantidad de maniobras o medicamentos adicionales. El sangrado transoperatorio fue, en promedio, de 845 ± 124,8 mL, para el grupo A, y de 709 ± 275,21 mL para el grupo B, en 21 pacientes del grupo A fue mayor de 1 000 mL y en 12 del grupo B. Conclusiones: las pacientes que recibieron carbetocina tuvieron resultados mejores en la contractilidad uterina. La necesidad de maniobras y medicamentos adicionales así como en la magnitud del sangrado y por tanto menor cantidad de transfusiones de hemoderivados(AU)

Introduction: the proper use of uterotonic drugs is fundamental in the management of obstetric hemorrhage. Objective: describe the effects of carbetocin and its comparison with oxytocin as the first choice to prevent obstetric hemorrhage in patients who are at risk for uterine atony. Methods: aprospective, comparative and cross-sectional study was conducted in 2016, which included 165 pregnant patients admitted for cesarean section, who had risk factors for uterine atony. Two groups were formed: A, with 110 patients receiving oxytocin at a dose of 10 U intravenously, and B, with 55 patients given 100 mcg of carbetocin after birth. Results: both groups were similar in age. In group A, the mean age was 27.5 years, and in B, 28.1 years. Adequate contractility was found in 83 patients in group A (75.45 percent) and 53 patients in group B (96.36 percent). The group receiving carbetocin required fewer maneuvers or additional medications. The intraoperative bleeding was, on average, 845 ± 124.8 mL in group A and 709 ± 275.21 mL in group B. It was more than 1,000 mL in 21 patients in group A and 12 patients in group B. Conclusions: patients who received carbetocin had better results in uterine contractility. The need for maneuvers and additional drugs was lesser as well as the magnitude of bleeding and therefore less transfusions of blood products(AU)

Oxytocin in cesarean-sections. What's new? / Ocitocina em cesarianas. O que há de novo?

Abstract Oxytocin is the uterotonic agent of choice in the prevention and treatment of postpartum uterine atony. Nevertheless, there is no consensus on the optimal dose and rate for use in cesarean sections. The use of high bolus doses (e.g., 10 IU of oxytocin) can determine deleterious cardiovascular changes for the patient, especially in situations of hypovolemia or low cardiac reserve. Furthermore, high doses of oxytocin for prolonged periods may lead to desensitization of oxytocin receptors in myometrium, resulting in clinical inefficiency.

Resumo A ocitocina é o uterotônico de primeira escolha na prevenção e no tratamento da atonia uterina após o parto. Apesar disso, não existe consenso sobre qual a dose e velocidade ideais de seu uso em cesarianas. O uso de altas doses (por exemplo, 10 UI de ocitocina) em bolus pode determinar alterações cardiocirculatórias deletérias para a paciente, especialmente em situações de hipovolemia ou baixa reserva cardíaca. Além disso, altas doses de ocitocina por períodos prolongados podem levar à dessensibilização dos receptores de ocitocina localizados no miométrio e resultar em ineficácia clínica.

Postpartum hemorrhage; comparison of efficacy of ergometrine with misoprostol in prophylaxis in cesarean section

Worldwide PPH remains one of the most common cause of maternal mortality and is largely preventable maternal deaths mainly in low income countries. 80% of it occurs due to uterine atony and uterotonics can decrease the risk of uterine atony. Misoprostol has powerful uterotonic effect because it is well absorbed and has potential to be used more widely than would be possible with injectable uterotonics alone. The objective of this study is to compare efficacy of misoprostol with ergometrine in cesarean delivery for management of PPH. Randomized controlled trial. The duration of study was six months from 1/1/2010 to 30th/6/2010. Department of Gynae and obstetrics, DHQ hospital, Faisalabad. All patients fulfilling inclusion criteria were included in study and before cesarean section Hb was carried out and Patients were divided into two groups, GP[1], and GP[2]. GP[1] was given 800 ug MP per rectal just before starting cesarean Section and GP[2] was given intravenous ergometrine at delivery of head or anterior 2 shoulder. Blood loss was measured objectively after delivery of the baby with help of standard size kidney tray of 500cc and post operative Hb was Carried out on 3rd post operative day. 187 Patients were randomly allocated in GP[1] and GP[2] each. In GP[1], misoprostol was given 800 microg per rectal just before starting cesarean section and 13 patients [7%] out of 187 have blood loss more than 500ml measured by standard size kidney tray while in GP[2] intravenous ergometrine was given at delivery of the head and in this group 25 patients [13.5%] out of 187 had 2 blood loss more than 500ml, so misoprostol was found to be a better uterotonic than ergometrine for prevention of PPH. On the third post operative day Hb was carried out and in GP[1] 13 patients [7%] out of 187 had their Hb less than 9 g/dl while in GP[2] 25 patients [13.5%] had Hb less than 9 g/d1. Mp is stable, cost effective and easily administrable drug and was found to be comparatively more powerful uterotonic than ergometrine for preventing uterine atony