Intramuscular oxytocin versus Syntometrine ^® versus carbetocin for prevention of primary postpartum haemorrhage after vaginal birth: a randomised double?blinded clinical trial of effectiveness, side effects and quality of life

Objective To compare intramuscular oxytocin, Syntometrine® and carbetocin for prevention of postpartum haemorrhage after vaginal birth. Design Randomised double-blinded clinical trial. Setting Six hospitals in England. Population A total 5929 normotensive women having a singleton Methods Randomisation when birth was imminent. Main outcome measures Primary: use additional uterotonic agents. Secondary: weighed blood loss, transfusion, manual removal placenta, adverse effects, quality life. Results Participants receiving uterotonics: 368 (19.5%) 298 (15.6%) Syntometrine 364 (19.1%) carbetocin. When pairwise comparisons were made: significantly more likely to receive uterotonics than those (odds ratio [OR] 1.28, 95% CI 1.08–1.51, P = 0.004); the difference between oxytocin non-significant (P 0.78); less (OR 0.75, 0.65–0.91, 0.002). Non-inferiority not shown. Use reduced non-drug PPH treatments compared with 0.64, 0.42–0.97) but 0.64). Rates transfusion different. associated an increase maternal effects ability mother bond her baby. Conclusions Carbetocin is different uterotonics. need oxytocin. Increased are disadvantage Syntometrine. Tweetable abstract IM does reduce or