Carbetocin Versus Misoprostol in High Risk Patients for Postpartum Hemorrhage After C.S. (PPH)
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|ClinicalTrials.gov Identifier: NCT02277067|
Recruitment Status : Recruiting
First Posted : October 28, 2014
Last Update Posted : November 22, 2018
|Condition or disease||Intervention/treatment||Phase|
|Postpartum Hemorrhage||Drug: Carbetocin Drug: Misoprostol||Phase 4|
- Postpartum hemorrhage was traditionally defined as blood loss in excess of 500 mL from a vaginal delivery or 1000 mL at cesarean section. It can result from uterine atony, retained placental tissue including that from abnormal placentation, maternal genital tract trauma and coagulopathies. (Almog et al, 2011)
- Uterotonic agents (e.g. ergometrine, misoprostol) should be easily accessible. Many units of an oxytocin infusion and/or rectal misoprostol during and after cesarean deliveries used to reduce the incidence of atony. -Misoprostol has been widely recommended for the prevention of post-partum hemorrhage when other methods are not available. The most common regimen reported for the treatment of post-partum hemorrhage is rectally. (Oladapo et al., 2012)
- Misoprostol is a prostaglandin E1 analogue. It has been investigated in the prevention of postpartum hemorrhage, using either the oral or rectal route of administration. (Hofmeyr et al, 2009)
- Carbetocin is a long-acting oxytocin studied by Dansereau et al.; 1999.They found that the carbetocin group of patients had a decreased incidence of PPH and of the need for therapeutic oxytocics. The recommended dose of carbetocin is 100 mg given either IM or slowly (over 1 minute).
Risk factors may present antenatally or intrapartum; care plans must be modified when risk factors present. Clinicians must be aware of risk factors for PPH and should take these into account for the wellbeing and safety of both the mother and the baby.RCOG GUIDLIN Table 1: Risk factors for PPH
- Suspected or proven placental abruption
- Known placenta praevia
- Multiple pregnancy
- Pre-eclampsia/gestational hypertension
- Previous PPH .
- Obesity (BMI >35)
- Anaemia (<9 g/dl)
- Delivery by elective caesarean section
- Induction of labour
- Retained placenta Tissue
- Prolonged labour (> 12 hours) .
- Big baby (> 4 kg) Royal College of Obstetrics and Gynecology.Green-top Guideline No. 52 May 2009 Minor revisions November 2009 and April 2011. Prevention and Management of Postpartum Hemorrhage. Thus our aim is to compare the effeciency and cost effectiveness of Carbitocin and Misoprostol in patients at high risk of PPH after C.S. in prevention of PPH.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||200 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)|
|Official Title:||Carbetocin Versus Misoprostol for Prevention of Postpartum Hemorrhage in Pregnant Women at High Risk Following C.S.|
|Study Start Date :||October 2014|
|Estimated Primary Completion Date :||August 2019|
|Estimated Study Completion Date :||August 2019|
Active Comparator: Pabal ( carbetocin)
Pabal (carbetocin which is a long acting oxytocin ) given as 100 mcg slow i.v. injection over 1 minute ( Draxis/Multiph). It will be given to the patients included in the study after delivery of the fetal head.
Pabal 100 mcg iv infusion over 1 minute given after delivery of fetal head In the first group of patients, carbitocin 100 mcg will be given iv infusion over one minute after delivery of the head in cesarean section.
Other Name: Pabal
Active Comparator: Misoprostol
Misoprostol ( Misotac, Sigma, Egypt) is a stable, synthetic form of prostaglandin E1 analogue. Patients wil be given 600 microgram of misotac immediately postoperative.
600 micro gram of misoprostol which is a prostaglandin E1 will be given per rectum for patients immediately postoperative.
Other Name: Misotac
- Uterine tone and size [ Time Frame: One hour after the cesarean section ]The uterine tone and size will be assessed by using a hand resting on the fundus and palpating the anterior wall of the uterus one hour after the operation. The presence of a boggy uterus with either heavy vaginal bleeding or increasing uterine size can suspect diagnosis of uterine atony.
- Blood loss [ Time Frame: One hour after cesarean section ]Blood loss will be estimated postoperatively by giving each woman of each group standard 2 dressings (standard weight of dressing is 25 gm) for one hour postoperative and recording weight of blood soaked dressings and volume of lost blood.
- Hemoglobin concentration [ Time Frame: Before and 24 hours after the operation ]Changes in hemoglobin concentrations before and 24 hours postoperative. Using a 10% fall in hematocrit value to define post-partum hemorrhage.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02277067
|Contact: Nesreen A Shehata, MDfirstname.lastname@example.org|
|Contact: Abdelgany M Hassan, MDemail@example.com|
|Principal Investigator: Nesreen A Shehata, Lecturer|
|Sub-Investigator: Abdelgany M Hassan, Lecturer|
|Principal Investigator:||Nesreen A Shehata, MD||Beni-Suef University|