Carbetocin, the front runner for post partum haemorrhage in heart disease complicating pregnancy at a tertiary care hospital

Abstract

: Post Partum Heamorrhage (PPH) is responsible for 47% of maternal mortality in India and one quarter of maternal deaths globally. Lack of expertise, lack of proper cold chain for oxytocin and cost limitations of heat stable carbetocin are major hurdles to prevent PPH. Restrained options for safer uterotonics in heart disease complicating pregnancy are a major concern. This study was conducted on 30 patients with heart disease complicating pregnancy who delivered at a tertiary care centre. All patients were administered single dose of carbetocin 100 mcg IM immediately after delivery and observed for development of PPH.: Carbetocin prevented PPH in 73.33% cases. Among 20% of COVID-19 positive patients, only one case had PPH. Major contributory factors in patients developing PPH include anemia before delivery, use of anticoagulant in antenatal period, instrumental delivery and high CARPREG 2 score. Less hemodynamic side effects even in patients with high CARPREG 2 score was appreciated. Carbetocin is a hemodynamically safer and effective uterotonic in heart disease complicating pregnancy. Increasing its availability and implementation in current guidelines is the way forward.