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: 6 hospitals in England POPULATION: 5929 normotensive women having a singleton vaginal birth. METHODS Randomisation when birth was imminent MAIN OUTCOME MEASURES: Primary: use of additional uterotonic agents. Secondary: weighed blood loss, transfusion, manual removal of placenta, side effects, quality of life. RESULTS Participants receiving additional uterotonics: 368 (19.5%) oxytocin, 298 (15.6%) Syntometrine and 364 (19.1%) carbetocin. When pairwise comparisons were made: women receiving carbetocin were significantly more likely to receive additional uterotonics than those receiving Syntometrine (OR 1.28, 95% CI 1.08-1.51, P=0.004); the difference between carbetocin and oxytocin was non-significant (p=0.78); Participants receiving Syntometrine were significantly less likely to receive additional uterotonics than those receiving oxytocin (OR 0.75, 95% CI 0.65-0.91, P=0.002). Non-inferiority between carbetocin and Syntometrine was not shown. Use of Syntometrine reduced non-drug PPH treatments compared with oxytocin (OR 0·64, 95%CI 0·42-0·97) but not carbetocin (p=0.64). Rates of PPH and blood transfusion were not different. Syntometrine was associated with an increase in maternal side effects and reduced ability to bond with her baby. CONCLUSIONS Non inferiority of carbetocin to Syntometrine was not shown. Carbetocin is not significantly different to oxytocin for use of additional uterotonics. Use of Syntometrine reduced use of additional uterotonics and need for non-drug PPH treatments compared with oxytocin. Increased maternal side effects are a disadvantage of Syntometrine.