| dc.description.abstract | The burden of maternal morbidity and mortality is highest in Sub Saharan Africa and Southern Asia.
Moreover, postpartum hemorrhage (PPH) is the largest contributor of maternal deaths in these regions. In
Kisumu County, most of these deaths occur at the regional referral hospital Jaramogi Oginga Odinga
Teaching and Referral Hospital (JOOTRH). The use of uterotonics for the prevention of postpartum
hemorrhage has resulted in a significant reduction in maternal morbidity and mortality, and thus remains
an integral part of active management of third stage of labor. WHO recommends use of oxytocin for
prevention of PPH in all births. Oxytocin is widely and readily available in most health facilities, including
JOOTRH, and continues to be the preferred first-line uterotonic drug for PPH prophylaxis. Carbetocin is a
heat-stable, longer-acting synthetic analog of oxytocin that is administered as a single dose within 1minute
of delivery. Proper management of PPH cannot be overemphasized because of its undisputed impact on
maternal morbidity and mortality. Although oxytocin is readily and widely available at JOOTRH and is
currently the preferred uterotonic agent for all births, there is paucity of data on the effectiveness of this
locally available drug. It is important to address the question of effectiveness of locally available oxytocin
to ensure PPH is effectively prevented. This was done in the form of a comparative study between the
standard first-line uterotonic, oxytocin and its analog carbetocin. This study aimed to evaluate the
effectiveness of carbetocin and oxytocin in preventing postpartum hemorrhage in women undergoing
cesarean delivery at JOOTRH. The specific objectives were to compare the incidences of use of additional
uterotonics between oxytocin and carbetocin, to compare blood pressure levels following administration of
oxytocin and carbetocin, to compare blood loss in the oxytocin and carbetocin groups, and to compare the
incidence of need for blood transfusion. This study was a quasi-experimental trial. Pregnant women who
underwent elective and emergency cesarean delivery at JOOTRH who met the eligibility criteria were
allocated to receive oxytocin until the desired sample size (77) was achieved, and subsequently allocated
to receive carbetocin until the desire sample of 77 was reached. A total of 154 women (77 for each study
arm) were recruited in the study. The intervention arm received 100mcg carbetocin IV, whereas the control
arm received 10IU oxytocin (the current standard of care). The sample size was calculated using a formula
by Charan & Biswas. OpenEpi, version 3, an open-source calculator, was used to confirm the power which
was 84.94%. Variables of interest were use of additional uterotonics, blood pressure readings, estimated
blood loss and need for transfusion. Blood pressure readings were summarized as means and standard
deviations while use of additional uterotonics, blood loss and need for transfusion were summarized as
frequency counts and percentages. Inferential analysis was used to analyze the collected data. Pearson's
Chi-square test of independence was used to assess the association between the study arm and the
sociodemographic and obstetric characteristics of the participants. Propensity score matching was used to
minimize selection bias. Binary logistic regression was employed to compare the use of additional
uterotonics, need for transfusion, and blood loss between the control and intervention groups, while blood
pressure changes were analyzed using linear regression analysis. In this study, we observed that participants
in the oxytocin arm were eight times more likely to receive additional uterotonics (OR=8.00, 95% CI
3.77,18.20, P-value <0.001). There were no statistically significant differences in systolic blood pressure
(P value 0.11), diastolic blood pressure (P value 0.30) and pulse rate (P value 0.20) measurements. There
was no statistically significant difference in blood loss (P-value 0.39) and need for transfusion (P-value
0.30) across the two groups. In conclusion, carbetocin was more effective in preventing PPH, as its use was
associated with a reduced need for additional uterotonics. There were no significant differences in blood
pressure changes, rates of blood loss, or need for transfusion. This study recommends that carbetocin be
included as a first-line agent in PPH prophylaxis in women undergoing cesarean delivery. | en_US |
