Carbetocin use in prevention of PPH in women with high risk: A Clinical Audit                           

Sufia Athar, Farhan Koujan, Joohi Ramawat, Omaima Ibrahim, Najat Ounissi, Yehia, Abdel Aziz,

Amna Tellisi, Ayman Hamcho, Lolwa Alansari

 

Objective: Despite the advancements in preventive strategies, post-partum hemorrhage remains a horrendous challenge to the physicians. It not only debilitates the maternal outcome but also, intensifies the financial burden. The key is to use preventive measures, specifically in those with high risks for post-partum hemorrhage (PPH).  Carbetocin has been used with promising results in negating PPH. A clinical audit is considered as an effective tool for improving the quality. So, we conducted an audit on the use and efficacy of Carbetocin in women with high risk for PPH.

Design: Prospective audit, using an audit cycle.

Methods:

Setting: Obstetrics and Gynecology department of a secondary care hospital at Qatar.

Participants: Women delivered at our facility in the time frame.

Time frame: April 2022-September 2022

Intervention: Use of Carbetocin for prevention of PPH in women with high risks for PPH based on the national clinical guidelines of Qatar. A clinical audit was performed at which a team of physicians reviewed the assessment of risks on admission and compliance with intake of Carbetocin on monthly basis. Post-partum blood loss, incidence of PPH and non-compliance was recorded. Feedback on compliance was given to the staff monthly.

Main outcome measures: The main outcomes were compliance with the use of Carbetocin and the prevalence of PPH. A comparison was made with cases with high risk, where Carbetocin was indicated but not used.  Differences in prevalence of PPH and average blood loss in both the groups were analyzed.

Results: Total women delivered were 2823. 11.41% women had at least one of the high risks. Overall compliance with intake of Carbetocin for high risk patients was 93%. PPH rates were 1.64% and 13.64% in the Carbetocin and oxytocin group respectively. The results were statistically significant (P = 0.0037). With use of Carbetocin, PPH rate was in comparison to cases with non-compliance. Compliance in the first month was 80.36% and gradually increased to 96% in the last month (p<0.05). 

Conclusion: Regular clinical audits of use of Carbetocin in women with high risks for PPH were associated with reduced rates of PPH, improved compliance and reduced maternal morbidity.