Carbetocin compared with oxytocin in non-elective Cesarean delivery: a systematic review, meta-analysis, and trial sequential analysis of randomized-controlled trials
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, C...
Gespeichert in:
| Veröffentlicht in: | Canadian journal of anesthesia 2020-11, Vol.67 (11), p.1524-1534 |
|---|---|
| Hauptverfasser: | , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1534 |
|---|---|
| container_issue | 11 |
| container_start_page | 1524 |
| container_title | Canadian journal of anesthesia |
| container_volume | 67 |
| creator | Onwochei, Desire N. Owolabi, Adetokunbo Singh, Preet Mohinder Monks, David T. |
| description | 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 randomized-controlled 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 (g·dL
−1
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; I
2
, 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. |
| doi_str_mv | 10.1007/s12630-020-01779-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2430369549</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2430369549</sourcerecordid><originalsourceid>FETCH-LOGICAL-c419t-93263e9125754464fd4059dc3f2a098eb36db117163b60bb97d9cb1bf1d960a23</originalsourceid><addsrcrecordid>eNp9kc9uFSEUxonR2NvqC7gwJG5cFAsDA4M7c6O1SRM3NXE3YeCM0szAFbit0wfyOaXOrSYuTCDnwPl9hz8fQi8YfcMoVWeZNZJTQps6mVKasEdow4SWpNOqfYw2tOMNkYx-OULHOV9TSjvZdk_REW-U6FinN-jn1qQBSrQ-YBvnnUng8K0v33D8sazbdYQYCExgi78BvIVcKROwg6mu0_IWG5yXXGA2xVuc4MbD7SmeoRhigpmW7PMpNsHhkryZcIbvewjlPn0o4zjiVIk4-ztwxMZQUpwmOEjyM_RkrAGeH-IJ-vzh_dX2I7n8dH6xfXdJrGC6EM3rj4BmTataIaQYnaCtdpaPjaG6g4FLNzCmmOSDpMOgldN2YMPInJbUNPwEvV777lKsl8yln322ME0mQNznvhGccqlboSv66h_0Ou5TfU-l2lZxKqhqK9WslE0x5wRjv0t-NmnpGe3vXexXF_vqYv_bxZ5V0ctD6_0wg_sjebCtAnwFci2Fr5D-nv2ftr8AY-Kq8A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2557304075</pqid></control><display><type>article</type><title>Carbetocin compared with oxytocin in non-elective Cesarean delivery: a systematic review, meta-analysis, and trial sequential analysis of randomized-controlled trials</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Onwochei, Desire N. ; Owolabi, Adetokunbo ; Singh, Preet Mohinder ; Monks, David T.</creator><creatorcontrib>Onwochei, Desire N. ; Owolabi, Adetokunbo ; Singh, Preet Mohinder ; Monks, David T.</creatorcontrib><description>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 randomized-controlled 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 (g·dL
−1
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; I
2
, 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.</description><identifier>ISSN: 0832-610X</identifier><identifier>EISSN: 1496-8975</identifier><identifier>DOI: 10.1007/s12630-020-01779-1</identifier><identifier>PMID: 32748189</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Anesthesiology ; Blood transfusions ; Cardiology ; Cesarean Section ; Critical Care Medicine ; Female ; Hemoglobin ; Hemorrhage ; Humans ; Intensive ; Medicine ; Medicine & Public Health ; Meta-analysis ; Oxytocics ; Oxytocin - analogs & derivatives ; Pain Medicine ; Pediatrics ; Pneumology/Respiratory System ; Postpartum Hemorrhage - epidemiology ; Postpartum Hemorrhage - prevention & control ; Pregnancy ; Randomized Controlled Trials as Topic ; Reports of Original Investigations ; Systematic review</subject><ispartof>Canadian journal of anesthesia, 2020-11, Vol.67 (11), p.1524-1534</ispartof><rights>Canadian Anesthesiologists' Society 2020</rights><rights>Canadian Anesthesiologists' Society 2020.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-93263e9125754464fd4059dc3f2a098eb36db117163b60bb97d9cb1bf1d960a23</citedby><cites>FETCH-LOGICAL-c419t-93263e9125754464fd4059dc3f2a098eb36db117163b60bb97d9cb1bf1d960a23</cites><orcidid>0000-0001-7676-9375</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12630-020-01779-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12630-020-01779-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32748189$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Onwochei, Desire N.</creatorcontrib><creatorcontrib>Owolabi, Adetokunbo</creatorcontrib><creatorcontrib>Singh, Preet Mohinder</creatorcontrib><creatorcontrib>Monks, David T.</creatorcontrib><title>Carbetocin compared with oxytocin in non-elective Cesarean delivery: a systematic review, meta-analysis, and trial sequential analysis of randomized-controlled trials</title><title>Canadian journal of anesthesia</title><addtitle>Can J Anesth/J Can Anesth</addtitle><addtitle>Can J Anaesth</addtitle><description>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 randomized-controlled 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 (g·dL
−1
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; I
2
, 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.</description><subject>Anesthesiology</subject><subject>Blood transfusions</subject><subject>Cardiology</subject><subject>Cesarean Section</subject><subject>Critical Care Medicine</subject><subject>Female</subject><subject>Hemoglobin</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Intensive</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Oxytocics</subject><subject>Oxytocin - analogs & derivatives</subject><subject>Pain Medicine</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Postpartum Hemorrhage - epidemiology</subject><subject>Postpartum Hemorrhage - prevention & control</subject><subject>Pregnancy</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Reports of Original Investigations</subject><subject>Systematic review</subject><issn>0832-610X</issn><issn>1496-8975</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp9kc9uFSEUxonR2NvqC7gwJG5cFAsDA4M7c6O1SRM3NXE3YeCM0szAFbit0wfyOaXOrSYuTCDnwPl9hz8fQi8YfcMoVWeZNZJTQps6mVKasEdow4SWpNOqfYw2tOMNkYx-OULHOV9TSjvZdk_REW-U6FinN-jn1qQBSrQ-YBvnnUng8K0v33D8sazbdYQYCExgi78BvIVcKROwg6mu0_IWG5yXXGA2xVuc4MbD7SmeoRhigpmW7PMpNsHhkryZcIbvewjlPn0o4zjiVIk4-ztwxMZQUpwmOEjyM_RkrAGeH-IJ-vzh_dX2I7n8dH6xfXdJrGC6EM3rj4BmTataIaQYnaCtdpaPjaG6g4FLNzCmmOSDpMOgldN2YMPInJbUNPwEvV777lKsl8yln322ME0mQNznvhGccqlboSv66h_0Ou5TfU-l2lZxKqhqK9WslE0x5wRjv0t-NmnpGe3vXexXF_vqYv_bxZ5V0ctD6_0wg_sjebCtAnwFci2Fr5D-nv2ftr8AY-Kq8A</recordid><startdate>20201101</startdate><enddate>20201101</enddate><creator>Onwochei, Desire N.</creator><creator>Owolabi, Adetokunbo</creator><creator>Singh, Preet Mohinder</creator><creator>Monks, David T.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FQ</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7676-9375</orcidid></search><sort><creationdate>20201101</creationdate><title>Carbetocin compared with oxytocin in non-elective Cesarean delivery: a systematic review, meta-analysis, and trial sequential analysis of randomized-controlled trials</title><author>Onwochei, Desire N. ; Owolabi, Adetokunbo ; Singh, Preet Mohinder ; Monks, David T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c419t-93263e9125754464fd4059dc3f2a098eb36db117163b60bb97d9cb1bf1d960a23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anesthesiology</topic><topic>Blood transfusions</topic><topic>Cardiology</topic><topic>Cesarean Section</topic><topic>Critical Care Medicine</topic><topic>Female</topic><topic>Hemoglobin</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Intensive</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Oxytocics</topic><topic>Oxytocin - analogs & derivatives</topic><topic>Pain Medicine</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Postpartum Hemorrhage - epidemiology</topic><topic>Postpartum Hemorrhage - prevention & control</topic><topic>Pregnancy</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Reports of Original Investigations</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Onwochei, Desire N.</creatorcontrib><creatorcontrib>Owolabi, Adetokunbo</creatorcontrib><creatorcontrib>Singh, Preet Mohinder</creatorcontrib><creatorcontrib>Monks, David T.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Canadian Business & Current Affairs Database</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Canadian journal of anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Onwochei, Desire N.</au><au>Owolabi, Adetokunbo</au><au>Singh, Preet Mohinder</au><au>Monks, David T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Carbetocin compared with oxytocin in non-elective Cesarean delivery: a systematic review, meta-analysis, and trial sequential analysis of randomized-controlled trials</atitle><jtitle>Canadian journal of anesthesia</jtitle><stitle>Can J Anesth/J Can Anesth</stitle><addtitle>Can J Anaesth</addtitle><date>2020-11-01</date><risdate>2020</risdate><volume>67</volume><issue>11</issue><spage>1524</spage><epage>1534</epage><pages>1524-1534</pages><issn>0832-610X</issn><eissn>1496-8975</eissn><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 randomized-controlled 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 (g·dL
−1
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; I
2
, 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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>32748189</pmid><doi>10.1007/s12630-020-01779-1</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-7676-9375</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0832-610X |
| ispartof | Canadian journal of anesthesia, 2020-11, Vol.67 (11), p.1524-1534 |
| issn | 0832-610X 1496-8975 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2430369549 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Anesthesiology Blood transfusions Cardiology Cesarean Section Critical Care Medicine Female Hemoglobin Hemorrhage Humans Intensive Medicine Medicine & Public Health Meta-analysis Oxytocics Oxytocin - analogs & derivatives Pain Medicine Pediatrics Pneumology/Respiratory System Postpartum Hemorrhage - epidemiology Postpartum Hemorrhage - prevention & control Pregnancy Randomized Controlled Trials as Topic Reports of Original Investigations Systematic review |
| title | Carbetocin compared with oxytocin in non-elective Cesarean delivery: a systematic review, meta-analysis, and trial sequential analysis of randomized-controlled trials |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-13T00%3A02%3A48IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Carbetocin%20compared%20with%20oxytocin%20in%20non-elective%20Cesarean%20delivery:%20a%20systematic%20review,%20meta-analysis,%20and%20trial%20sequential%20analysis%20of%20randomized-controlled%20trials&rft.jtitle=Canadian%20journal%20of%20anesthesia&rft.au=Onwochei,%20Desire%20N.&rft.date=2020-11-01&rft.volume=67&rft.issue=11&rft.spage=1524&rft.epage=1534&rft.pages=1524-1534&rft.issn=0832-610X&rft.eissn=1496-8975&rft_id=info:doi/10.1007/s12630-020-01779-1&rft_dat=%3Cproquest_cross%3E2430369549%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2557304075&rft_id=info:pmid/32748189&rfr_iscdi=true |