Oxytocin agonists for reducing postpartum haemorrhage.
In low/middle income countries, postpartum haemorrhage is a major cause of maternal mortality and morbidity. In high-income countries, the problems are much less but there is still a small risk of major bleeding problems for women after giving birth. Active management of the third stage of labour, which is generally used to reduce blood loss at birth, has three interrelated components: a drug that helps the uterus to contract, early cord clamping and controlled cord traction. Different drugs have been tried, and generally either intramuscular oxytocin or intramuscular syntometrine are given. Oxytocin agonists are a group of drugs that mimic oxytocin action, oxytocin being the hormone that helps to reduce blood loss at birth. The review of trials found four studies, involving 966 participants. Most trials compared carbetocin (oxytocin agonist) against oxytocin, mostly given intravenously, either in women giving birth vaginally who were at increased risk, or by elective caesarean deliveries. Limited evidence suggests that there is little difference in the effectiveness between carbetocin and oxytocin, and adverse effects like headache, nausea and vomiting were also similar. No outcomes were assessed on the baby, and three studies were known to be supported by grants from a pharmaceutical company. Further larger studies are needed.