Expression of Concern: Carbetocin versus sublingual misoprostol plus oxytocin infusion for prevention of postpartum hemorrhage at cesarean section in patients with risk factors: a randomized, open trail study

OBJECTIVES:To compare combined sublingual misoprostol plus oxytocin infusion with intravenous carbetocin for prevention of postpartum hemorrhage (PPH) in patients with risk factors during cesarean section (CS). METHODS:In this randomized study, 380 patients were randomly allocated to receive either combined 400 μg sublingual misoprostol before surgery plus 20 IU oxytocin after delivery of baby (n = 190) or intravenous 100 μg carbetocin (n = 190). The main outcome measure was requirement of additional pharmacological uterotonic. Secondary outcomes were the difference in preoperative and postoperative hemoglobin, estimated blood loss, incidence of blood transfusion and adverse effects. RESULTS:16.3 % of women who received sublingual misoprostol plus oxytocin infusion required additional uterotonic versus 13.7 % of women who received intravenous carbetocin with no significant difference (p = 0.27). No significant difference between treatment groups in preoperative and postoperative hemoglobin level change, estimated blood loss, incidence of blood transfusion was observed. Shivering and fever were significantly higher with misoprostol plus oxytocin (p = <0.001 and <0.001, respectively). CONCLUSION:Both sublingual misoprostol plus oxytocin infusion and intravenous carbetocin are similarly effective for the prevention of PPH in patients with risk factors during CS.