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Evidence review identifies best drug options to stop bleeding in women after childbirth

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Alternative drugs may be more effective than the standard drug currently used to stop women bleeding after childbirth, according to a Cochrane review of available evidence.

The authors of the systematic review of studies, from the University of Birmingham, noted that postpartum haemorrhage was the most common reason why mothers die in childbirth worldwide.

“Our research has highlighted which drugs may be more effective than oxytocin”

Ioannis Gallos

They highlighted that routine administration of the uterotonic drug oxytocin had become standard global practice to reduce excessive bleeding at childbirth and was backed by the World Health Organization.

However, their review found several uterotonic combinations, as well as another drug its own, were more effective for reducing excessive bleeding than the current standard singular use of oxytocin.

The safer combinations identified by the researchers were ergometrine plus oxytocin and also misoprostol plus oxytocin. Meanwhile, carbetocin on its own was also safer than just oxytocin.

The researchers, from the Cochrane Pregnancy and Childbirth Group, reviewed the data of the births of 88,000 women who took part in 140 randomised trials.

They assessed which uterotonics – including oxytocin, misoprostol, ergometrine, carbetocin and in combination – were most effective in preventing excessive bleeding and had the least side-effects.

“We hope that this could impact existing recommendations and save mothers lives worldwide”

Ioannis Gallos

The team analysed all the available evidence to compare all of the drugs and calculated a ranking among them, providing robust effectiveness and side-effect profiles for each drug.

“The three most effective drugs for prevention of postpartum haemorrhage were ergometrine plus oxytocin combination, carbetocin, and misoprostol plus oxytocin combination,” the review authors stated, with oxytocin by itself the fourth best option.

Based on their results, they said about 10.5% women given oxytocin would experience a postpartum haemorrhage, compared with 7.2% given ergometrine plus oxytocin combination, 7.6% given carbetocin, and 7.7% given misoprostol plus oxytocin.

The outcomes and rankings for postpartum haemorrhage were similar whether the drugs were given in doses of around 500mL or 1,000mL, said the researchers, whose findings have been published this week by the well-respected Cochrane Library.

Cochrane review author Dr Ioannis Gallos, from Birmingham University, said: “Whilst death from postpartum haemorrhage is a rare complication, it is the most common reason why mothers die in childbirth.”

He reiterated that standard practice across the world to reduce excessive bleeding was to administer oxytocin, which contracts the uterus and stimulates contractions to help push out the placenta.

“However, there are a number of other uterotonics and combinations of these drugs that can be given that may be more effective,” he noted.

University of Birmingham

Review identified best drugs to stop bleeding after childbirth

Ioannis Gallos

“By analysing data from 140 different clinical trials involving over 88,000 women, we have been able to use the evidence more efficiently to compare all of these drugs and calculate a ranking among them, providing robust effectiveness and side-effect profiles for each drug,” he said.

“Our research has highlighted which drugs may be more effective than oxytocin and we hope that this could impact existing recommendations and save mothers lives worldwide,” he added.

This Cochrane review is expected to be updated later this year to incorporate the results of some key ongoing studies which will report their findings in coming months.

These include a large study involving around 30,000 women across 10 countries comparing the effectiveness of carbetocin versus oxytocin for preventing bleeding in women having a vaginal birth.

A further study likely to be included is a UK-based trial involving more than 6,000 women comparing carbetocin, oxytocin and ergometrine plus oxytocin combination.

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