Carbetocin compared with oxytocin in non-elective Cesarean delivery: a systematic review, meta-analysis, and trial seque
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Carbetocin compared with oxytocin in non-elective Cesarean delivery: a systematic review, meta-analysis, and trial sequential analysis of randomized-controlled trials Comparaison de la carbe´tocine a` l’ocytocine pour un accouchement par ce´sarienne non planifie´ : revue syste´matique, me´ta-analyse et analyse se´quentielle des e´tudes randomise´es controˆle´es Desire N. Onwochei, MBBS David T. Monks, MBChB
. Adetokunbo Owolabi, MBBS . Preet Mohinder Singh, MD .
Received: 2 April 2020 / Revised: 21 May 2020 / Accepted: 25 May 2020 Ó Canadian Anesthesiologists’ Society 2020
Abstract Purpose Carbetocin has been shown to reduce the requirement for additional uterotonics in women exclusively undergoing elective Cesarean delivery (CD). The aim of this review was to determine whether this effect could also be demonstrated in the setting of non-elective CD. Methods Medline, Embase, CINAHL, Web of Science and Cochrane databases were searched for randomizedcontrolled trials (RCTs) in any language comparing carbetocin to oxytocin. Studies with data on women undergoing non-elective CD, where carbetocin was compared with oxytocin, were included. The primary outcome was the need for additional uterotonics. Secondary outcomes included incidence of blood transfusion, estimated blood loss (mL), incidence of postpartum hemorrhage (PPH; [ 1000 mL) and mean hemoglobin drop (gdL-1
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-020-01779-1) contains supplementary material, which is available to authorized users. D. N. Onwochei, MBBS (&) A. Owolabi, MBBS Department of Anaesthesia, Guy’s & St. Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK e-mail: [email protected] P. M. Singh, MD D. T. Monks, MBChB Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
Results Five RCTs were included, with a total of 1,214 patients. The need for additional uterotonics was reduced with carbetocin compared with oxytocin (odds ratio, 0.30; 95% CI, 0.11 to 0.86; I2, 90.60%). Trial sequential analysis (TSA) confirmed that the information size needed to show a significant reduction in the need for additional uterotonics had been exceeded. No significant differences were shown with respect to any of the secondary outcomes, but there was significant heterogeneity between the studies. Conclusions Carbetocin reduces the need for additional uterotonics in non-elective CD compared with oxytocin. TSA confirmed that this analysis was appropriately powered to detect the pooled estimated effect. Further trials utilizing consistent core outcomes are needed to determine an effect on PPH. Trial registration PROSPERO CRD42019147256, registered 13 September 2019. Re´sume´ Objectif Il a e´te´ de´montre´ que la carbe´tocine re´duisait les besoins en ute´rotoniques supple´mentaires exclusivement chez les femmes subissant un accouchement par ce´sarienne planifie´. L’objectif de ce compte rendu e´tait de de´terminer si cel
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