January 2018 · Volume 7 · Issue 1 Page 10 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Ali AA et al. Int J Reprod Contracept Obstet Gynecol. 2018 Jan;7(1):10-14 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Original Research Article Carbetocin versus Oxytocin and Misoprostol in prevention of atonic post-partum hemorrhage in high risk patients planed for cesarean delivery Abd El-Naser Abd El-Gaber Ali 1 , Ahmed Ali M. Nasr 2 *, Hazem H. Ahmed 1 , Mahmoud I. El- Rasheedy 2 , Mahmoud Badawy 2 INTRODUCTION Primary postpartum hemorrhage (PPH) is a major cause of maternal mortality, with a worldwide prevalence of ~6%. 1 PPH arises mainly from the failure of the uterus to contract after delivery, leading to blood loss of 500 ml in vaginal delivery, >1000 ml in cesarean section (CS), or a substantial drop in hematocrit compared with the antepartum level; those conditions may occur in the first 24 hours after delivery (primary PPH) or between 24 hours and 6 weeks after delivery (secondary PPH). 2,3 Risk factors for atonic PPH include history of prior PPH, large ABSTRACT Background: Post-partum hemorrhage prevention (PPH) is considered a major issue due to its effect on maternal morbidity and mortality. The objective of this study was to compare efficacy of Carbetocin in prevention of atonic post-partum hemorrhage in high risk patients undergoing elective caesarean section in comparison to Oxytocin and Misoprostol. Methods: 150 pregnant women prepared for elective caesarean section were classified into 3 groups; Group I (50 patients received Carbetocin 100 mg I.V infusion), Group II (50 patients received 20 IU of Oxytocin infusion on 1000 ml of normal saline solution) and Group III (50 cases received Misoprostol 400 μg per rectum immediately before induction of anaesthesia). Assessment of PPH and its degree was determined according to amount of blood loss during and for first 24 hours of caesarean delivery, also further need for haemostatic measures were also assessed. Results: There was a statistically significant difference in PPH among the three groups 6, 14 and 12% for group I, II and III respectively (P <0.001), major PPH was 0, 4 and 6% for the same groups respectively (P <0.001). The need for additional uterotonic agents was significantly lesser in Group I compared to Group II and III (2% versus 8 and 12% respectively P = 0.02) also the need for additional surgical measures was significantly lesser among the three groups (P= 0.00). The drop in Hb level and haematocrit value was significantly lesser in group I compared to group II& III (P <0.05). The need for blood transfusion was significantly lesser in Group I compared to group II and III (0% versus 12% p <0.0001) Conclusions: Carbetocin was superior to Oxytocin and Misoprostol in prevention of atonic PPH in high risk patients underwent elective caesarean delivery. Carbetocin should be administered for all cases undergoing elective CS and carry a risk factor for postpartum hemorrhage. Keywords: Carbetocin, Cesarean section, Misoprostol, Oxytocin, Postpartum hemorrhage DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20175824 1 Department of Obstetrics and Gynecology, Faculty of Medicine South Valley, University, Egypt 2 Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Egypt Received: 16 October 2017 Accepted: 17 November 2017 *Correspondence: Dr. Ahmed Ali M. Nasr, E-mail: aam_nasr@yahoo.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.