Carbetocin at Elective Cesarean Delivery Part 3

Samuel Lunenfeld Research Institute, Mount Sinai Hospital

Status: Completed

Conditions: Postpartum Hemorrhage

Treatments: Drug: Carbetocin

Study type: Interventional

Funder types: Other

Identifiers

NCT01651130

12-04

Details and patient eligibility

About

Post-partum hemorrhage (PPH) is a major cause of maternal death worldwide. Oxytocin is the most common uterotonic drug used to prevent and treat PPH in North America, however, there are some limitations to its use. Oxytocin has a very short duration of action, which requires a continuous infusion to achieve sustained uterotonic activity. The Society of Obstetricians and Gynecologists of Canada (SOGC) has recently recommended a single 100mcg dose of carbetocin at elective Cesarean delivery to promote uterine contraction and prevent post partum hemorrhage (PPH), in lieu of the more traditional oxytocin regimens. Carbetocin lasts 4 to 7 times longer than oxytocin, with a similar side effect profile and apparent greater efficacy rate. However, a dose response study to determine the minimum effective dose of carbetocin has not yet been published. The investigators hypothesize that the minimum effective dose (ED90) is at least 20mcgs (or perhaps below) in women undergoing elective Cesarean delivery.

Full description

The Society of Obstetricians and Gynecologists of Canada (SOGC) recently recommended a 100mcg intravenous bolus dose of carbetocin following Cesarean delivery.

Studies thus far show that carbetocin may be just as effective as oxytocin in promoting uterine contraction, with a similar side effect profile. In addition, patients receiving carbetocin may experience less blood loss, and require less additional uterotonics when compared with oxytocin. Two dose response studies conducted at our institution (by Cordovani et al, and Anandakrishnan et al) suggested no difference in efficacy of uterine contraction for doses of carbetocin between 20-120mcg. Hypotension was noted for all dose groups studied.

This study will be conducted as a prospective, randomized, up-down sequential allocation trial. The success or fail of a patient in the study will determine the dose given to future patients. Dosage will be increased for patients following a failed case, and kept the same for patients following successful cases. Following a successful case, there is also a 1 in 9 chance that the dose will be decreased for the next patient.

The results of this follow-up study will define the minimum required dose of carbetocin for uterine contraction, thus minimizing unnecessary side effects, improving quality and safety of patient care. It may also contribute in establishing carbetocin as a substitute to oxytocin for elective cesarean section at our institution as well as others.

Enrollment: 40 patients

Sex: Female

Ages: 18 to 55 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Patients planned for elective cesarean delivery under spinal anesthesia
• Patients who give written informed consent to participate

Exclusion criteria

• Patients who refuse to give written informed consent
• Patients who claim allergy or hypersensitivity to carbetocin or oxytocin
• Patients with conditions that predispose to uterine atony and postpartum hemorrhage such as placenta previa, multiple gestation, preeclampsia, eclampsia, macrosomia, polyhydramnios, uterine fibroids, previous history of uterine atony and postpartum bleeding, or bleeding diathesis.
• Patients with hepatic, renal, and vascular disease
• Patients requiring general anesthesia prior to the administration of the study drug.

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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40 participants in 6 patient groups

Carbetocin 100mcg

Active Comparator group

Description:

Carbetocin 100mcg, once following delivery of the fetal head.

Treatment:

Drug: Carbetocin

Carbetocin 20mcg

Active Comparator group

Description:

Carbetocin 20mcg, once following delivery of the fetal head.

Treatment:

Drug: Carbetocin

Carbetocin 15mcg

Active Comparator group

Description:

Carbetocin 15mcg, once following delivery of the fetal head.

Treatment:

Drug: Carbetocin

Carbetocin 10mcg

Active Comparator group

Description:

Carbetocin 10mcg, following delivery of the fetal head.

Treatment:

Drug: Carbetocin

Carbetocin 5mcg

Active Comparator group

Description:

Carbetocin 5mcg, following delivery of the fetal head.

Treatment:

Drug: Carbetocin

Carbetocin 2mcg

Active Comparator group

Description:

Carbetocin 2mcg, following delivery of the fetal head.

Treatment:

Drug: Carbetocin