ABSTRACT
OBJECTIVE: In patients with severe preeclampsia there is an increased risk of postpartum hemorrhage, but the hemodynamic changes associated with severe preeclampsia make the management of any kind of bleeding particularly troublesome. There are many pharmacological options for the management of postpartum hemorrhage, oxytocin being the first line of treatment. There is as yet no evidence about the safety and efficacy of using carbetocin, an oxytocin agonist, in these patients. We aimed to compare oxytocin with carbetocin for the routine prevention of postpartum hemorrhage in patients with severe preeclampsia. METHODS: We performed a prospective double-blind randomized controlled trial in 60 women with severe preeclampsia, recruited between July and September 2010. The women were randomized to receive either oxytocin or carbetocin during the third stage of labour. The primary outcome measure was postpartum hemorrhage requiring additional uterotonics, and the secondary outcome measures were the difference in hemoglobin levels between groups, the development of oliguria, and hemodynamic status (mean arterial pressure and heart rate) after administration of the drug. RESULTS: Carbetocin was as effective as oxytocin in the prevention of postpartum hemorrhage in women with severe preeclampsia. Carbetocin had a safety profile similar to that of oxytocin, and it was not associated with the development of oliguria or hypertension in this cohort. CONCLUSIONS: Carbetocin is an appropriate alternative to oxytocin for the prevention of postpartum hemorrhage in women with severe preeclampsia. Considering that it appears not to have a major hemodynamic effect in women with severe preeclampsia and that it uses a lower volume per dose than oxytocin, it should be considered a valid option in the management of the third stage of labour in women with hypertensive disorders of pregnancy.
Subject(s)
Oxytocics/therapeutic use , Oxytocin/analogs & derivatives , Oxytocin/therapeutic use , Postpartum Hemorrhage/prevention & control , Pre-Eclampsia/physiopathology , Double-Blind Method , Female , Humans , Oxytocin/adverse effects , Placebos , Pregnancy , Prospective StudiesABSTRACT
To present the main results of the regional situation diagnosis and intervention plan developed in 2010 as part of the planning activities of the Mesoamerican Health System by the Working Group on Maternal, Reproductive and Neonatal Health. A group of experts and representatives from countries in the region (Central America and nine southern Mexican states) conducted an exhaustive review of available data to construct a situational analysis and a review of effective practices for improving maternal, reproductive and neonatal health. Finally, the group proposed a regional action plan, defining regional goals and specific interventions. The situational diagnosis suggests that, although there has been progress in the last 10 years, maternal and neonatal mortality rates are still unnaceptably high in the region, with a substantial variability across countries. The group proposed as a regional goal the reduction of maternal and neonatal mortality in accordance with the Millenium Development Goals. The regional plan recommends specific maternal and neonatal health interventions emphasizing obstetric and neonatal emergency care, skilled birth attendance and family planning. The plan also includes a five year implementation strategy, along with training and evaluation strategies. The regional plan for maternal, neonatal and reproductive health has the potential to be successful, provided it is effectively implemented.
Subject(s)
Health Promotion/organization & administration , Infant Welfare , Maternal Welfare , Reproductive Health , Adolescent , Adult , Central America , Child , Child Health Services/organization & administration , Child Health Services/supply & distribution , Developing Countries , Family Planning Services , Female , Goals , Health Plan Implementation , Health Services Needs and Demand , Humans , Infant Mortality/trends , Infant, Newborn , International Cooperation , Maternal Health Services/organization & administration , Maternal Health Services/supply & distribution , Maternal Mortality/trends , Mexico , Middle Aged , Pregnancy , Regional Health Planning , Young AdultABSTRACT
Presentar los principales resultados del diagnóstico situacional y plan regional de intervenciones en salud materna, reproductiva y neonatal elaborado como parte de los trabajos del Sistema Mesoamericano de Salud por el grupo de salud materna, reproductiva y neonatal (SMRN) en 2010. Se conformó un grupo de expertos y de representantes de los países de la región (que incluye Centroamérica y nueve estados del sur de México). Se hizo una revisión documental para conformar un diagnóstico situacional, una revisión de prácticas efectivas y se conformó un plan regional de acción. El diagnóstico situacional indica que las tasas de mortalidad materna y neonatal se mantienen inaceptablemente altas en la región. Se propuso como meta regional reducir la mortalidad materna y neonatal de acuerdo a los Objetivos de Desarrollo del Milenio. Se conformó un plan regional que identifica intervenciones específicas en SMRN con énfasis en la atención adecuada a las emergencias obstétricas y neonatales, atención calificada al nacimiento, y en planificación familiar. Se sugiere asimismo un plan de implementación a cinco años y una estrategia de evaluación y de capacitación. El plan regional en SMRN puede tener éxito siempre y cuando los aspectos de implementación sean atendidos debidamente.
To present the main results of the regional situation diagnosis and intervention plan developed in 2010 as part of the planning activities of the Mesoamerican Health System by the Working Group on Maternal, Reproductive and Neonatal Health. A group of experts and representatives from countries in the region (Central America and nine southern Mexican states) conducted an exhaustive review of available data to construct a situational analysis and a review of effective practices for improving maternal, reproductive and neonatal health. Finally, the group proposed a regional action plan, defining regional goals and specific interventions. The situational diagnosis suggests that, although there has been progress in the last 10 years, maternal and neonatal mortality rates are still unnaceptably high in the region, with a substantial variability across countries. The group proposed as a regional goal the reduction of maternal and neonatal mortality in accordance with the Millenium Development Goals. The regional plan recommends specific maternal and neonatal health interventions emphasizing obstetric and neonatal emergency care, skilled birth attendance and family planning. The plan also includes a five year implementation strategy, along with training and evaluation strategies. The regional plan for maternal, neonatal and reproductive health has the potential to be successful, provided it is effectively implemented.
