Postpartum Hemorrhage Clinical Trial
Official title:
Carbetocin Versus Ergometrin in the Prevention of Postpartum Hemorrhage in Parturients Undergoing Caesarian Section Under Regional Anaesthesia. A Single Blind Randomized Control Trial
In the present study will be compared Carbetocin with ergometrin in the prevention of postpartum haemorrhage (PPH) in parturients that are undergoing caesarean section and are not presenting risk factors for PPH. As indicators will be used intraoperative blood loss, as well as the value of hemoglobin and hematocrit 24 hours after the caesarian section.
In the particular study the investigators will compare the effect of Carbetocin and
ergometrin in the prevention of postpartum haemorrhage. It is a prospective comparative
single blind randomized study which will be carried out in the G.N.M.A. "Elena Venizelou".
The protocol will be filed in an international database before the initiation of the study
(eg. ClinicalTrials.gov). The sample will be constituted by parturients that will undergo
Caesarean section. The parturients will be divided in two groups: the group to which
carbetocin will be administered and the group to which ergometrin will be used as the main
uterotonic drug. Randomization will be achieved with the help of a computer and the method
¨sealed envelope¨. In this method the investigator receives a sealed envelope either by mail
or by computer, in which a random number will be placed. This number will correspond to one
of the treatments. For greater reliability in the results some exclusion criteria will be
set.
A consent form will be given to the parturients that will have to sign after it is explained
to them the purpose of the study and that there is a rescue treatment in case of failure of
the medication is administered to them. Subsequently a complete medical background will be
obtained and it will be performed the standard laboratory control which includes: a blood
count, coagulation parameters, biochemical parameters and an assessment by a cardiologist.
Regional anaesthesia will then be performed (spinal, epidural or combined spinal-epidural).
After the embryo exit and placental detachment in the ergometrine group will be administered
intravenously 0.2 mg of the substance slowly in a bolus administration, while in the
carbetocin group will be administered 100 mcg of carbetocin diluted in 100 cc of N/S 0.9% in
a continuous rapid-flow intravenous infusion.
The efficacy of the uterotonic drugs will be assessed with a new hemoglobin and hematocrit
count 24 hours after the end of the cesarean section, as well as by intraoperative blood loss
which will be calculated by weighing gauzes and compresses after the end of the operation, by
the amount of blood present in the suction unit and by the blood present in the surroundings
of the operating table (9). It is obvious that if necessary rescue therapy will be
administered which will consist of 15 iu of oxytocin in intravenous infusion in the
ergometrin group and 0.2 mg of ergometrin in slow bolus administration in the carbetocin
group, as well as 3 tb of misoprostol in both groups administered per rectum.
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