الفهرس 
Title : Carbetocin versus syntocinon for prevention of postpartum hemorrhage in cardiac patients with stenotic valvular heart disease undergoing caesarean section
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Abstract
Background and Rationale: Postpartum hemorrhage (PPH) is the primary cause of nearly one quarter of all maternal deaths globally. Management of uterine tone after delivery involves giving a prophylactic uterotonic and the use of controlled cord traction to facilitate delivery of the placenta and minimise blood loss. Syntocinon and carbetocin are the most commonly used drugs. They were discussed before but in non cardiac patients. Maternal heart disease complicates 0.2%-3% of pregnancies. As for mitral & aortic stenosis. goals for labor and delivery include maintenance of SVR, intravascular volume, sinus rhythm and a normal rate. we hypothesized that carbetocin is better than syntocinon as prophylaxis for postpartum haemorrhage in cardiac patients with stenotic valve lesions regarding its effect on cardiac output and other hemodynamics.
Patients and methods: The study included 40 pregnant female patients (18- 45 years old) with cardiac stenotic lesions (mitral stenosis, aortic stenosis) undergoing caesarean section under general anaesthesia. Patients were randomized into two groups (twenty in each group): carbetocin group & syntocinon group. Our primary outcome was change in cardiac output 1min after drug administration. Our secondary outcomes were COP, SVR, blood pressure, heart rate. blood loss, uterine contractility and the need for rescue doses till end of surgery. COP, SVR, blood pressure and heart rate were recorded before anesthesia, after induction of anesthesia, during delivery of the fetus, 1 minute after injection of the study drug then every 2 minutes for two readings then every 5 minutes till end of surgery.
Results: the cardiac output readings were comparable between the two groups. The heart rate, systolic blood pressure and systemic vascular resistance were generally comparable between the two groups. After drug administration, the
systolic blood pressure was generally maintained in the carbetocin group. It decreased in relation to baseline in the syntocinon group starting 3 minutes post drug injection which was statistically significant (P-value: 0.002)) and 20 minutes post drug injection in carbetocin group (P-value:0.044). The incidence of hypotension was comparable between the two groups (one patient [5%] in the carbetocin group and 0 [0%] in the syntocinon group, P- value: 0.323).
The number of mothers needing rescue uterotonic bolus were significantly more in syntocinon group than in carbetocin group 5 (26%) versus 0 (0%), respectively, P-value: 0.014) .The blood loss was comparable between the two groups, and none of the included mothers needed blood transfusion. Conclusion: in full-term pregnant women with stenotic valvular lesions, the cardiac output readings were comparable between the two groups. Carbetocin was associated with more stable hemodynamic profile (regarding systolic blood pressure).