Oxytocin, Carbetocin and Misopristol for Treatment of Postpartum Hemorrhage: A Multicentric Randomized Trial

Sohag University

Status: Unknown

Conditions: Postpartum Hemorrhage

Treatments: Drug: carbetocin; Drug: misopristol; Drug: oxytocin

Study type: Interventional

Funder types: Other

Identifiers

NCT01600612

salah-1

Details and patient eligibility

About

Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide, with an estimated mortality of 140 000 per year. Uterine atony is one of the most important causes of PPH. The traditional treatment of which is the use of uterotonic agents. Oxytocin is the most conventional drug which was proved effective. However, it has the shortcomings of short half life and the necessity of intravenous administration. Misopristol, and more recently Carbetocin were introduced for treatment of atonic PPP not responding to Oxytocin.

Aim of the study is to evaluate the effectiveness of Carbetocin, Misopristol, and Oxytocin for treatment of atonic PPH.

Full description

The study will be conducted at the departments of Obstetrics and Gynecology of Sohag, Qena, Al Azhar, and Assuit university hospitals, Egypt. All patients with atonic PPH who delivered vaginally will be invited to participate in the study. Patients who delivered by caesarean section, with retained placenta, with traumatic PPH, associated coagulopathy and those refused to participate in the study will be excluded. The patients will be randomly categorized into 3 groups; the first (n = 100) will receive 30 IU oxytocin intravenously; the second (n = 100) will receive 600 ug misopristol sublingually; the third (n = 100) will receive 100 ug Carbetocin IV. The randomization will be done using opaque sealed envelops containing computer-generated codes. The primary outcome of the study is cessation of bleeding which will be judged by visual inspection of the blood loss by the trialist and by loss of < 300 mL of blood during the first hour after enrollment. The secondary outcomes are time of control of bleeding (minutes), amount of blood loss till control of bleeding (mL), changes in the hemoglobin levels (gm) before and after treatment, Changes in the hematocrite values (%) before and after treatment, the use of additional uterotonic drugs, the rate of complications (%), and the necessity for surgical intervention, and the cost of each medication.

Written consent will be obtained from all participants and approval from the local institutional ethical committee will be included.

Enrollment: 300 estimated patients

Sex: Female

Volunteers: No Healthy Volunteers

Inclusion criteria

• primary atonic postpartum hemorrhage after vaginal delivery

Exclusion criteria

• Patients who delivered by caesarean section
• Retained placenta
• Traumatic postpartum hemorrhage
• Associated coagulopathy
• Chronic medical illness (hepatic , renal diseases)
• Refusal to participate in the study.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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300 participants in 3 patient groups

Oxytocin

Active Comparator group

Description:

30 IU of oxytocin will be given intravenously to patients with atonic postpartum hemorrhage

Treatment:

Drug: oxytocin

carbetocin

Active Comparator group

Description:

10 ug of carbetocin will be given intravenously to patients with atonic postpartum hemorrhage

Treatment:

Drug: carbetocin

misopristol

Active Comparator group

Description:

600 ug of misopristol sublingually will be given intravenously to patients with atonic postpartum hemorrhage

Treatment:

Drug: misopristol