Reducing Risk of Postpartum Haemorrhage in LMICs

­Worldwide around 127,000 women die each year due to postpartum haemorrhage (the loss of 500ml of blood within the first 24 hours after giving birth), making it the most common cause of maternal death.[1] It is especially prevalent in low- or middle-income countries (LMICs). The standard treatment is administration of oxytocin – however, the drug needs to be kept at 20-25°C, which can be difficult in some countries where refrigeration isn’t reliable in either the hospital or whilst being transported. Thus, there is a need for an alternative option. Widmer and colleagues conducted a double-blind RCT of nearly 30,000 women across ten countries comparing postpartum administration of oxytocin with carbetocin, a heat-stable oxytocin analogue that can be stored at room temperature.[2] Both groups of women showed similar frequencies of blood loss – 14.4% of those given oxytocin lost >500ml of blood, compared to 14.5% given carbetocin (relative risk 1.01, 95% CI 0.95-1.06); while, respectively, 1.45% and 1.51% lost >1000ml of blood (relative risk 1.04, 95% CI 0.87-1.25). There were also no significant differences in necessary interventions or adverse events.

Carbetocin could even perform better than oxytocin in LMICs as the oxytocin was stored in optimum conditions, which may not accurately reflect real-life settings. It will be interesting to track the implementation to uptake of this new finding – any takers?

— Peter Chilton, Research Fellow

References:

  1. World Health Organization. Making Pregnancy Safer. Issue 4. Geneva, CHE: World Health Organization; 2007.
  2. Widmer M, Piaggio G, Nguyen TMH, et al. Heat-Stable Carbetocin versus Oxytocin to Prevent Hemorrhage after Vaginal Birth. New Engl J Med. 2018.
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