Initial heavy bleeding after childbirth. Bleeding some blood during and after delivery is normal during pregnancy; the amount of blood in the body almost doubles, so a small amount of blood [1].Bleeding during childbirth does not pose any problem, but if the bleeding is more than the average amount, the patient will feel tired and weak [2]

A loss of more than 500 milliliters of blood after a vaginal delivery, or more than 1,000 milliliters after cesarean delivery [3].A loss of more than 1,000 milliliters after vaginal delivery is considered very severe postpartum bleeding. More than half of postpartum hemorrhages occur unexpectedly, and there is no way to predict their occurrence. One of the factors that may cause postpartum hemorrhage is high blood pressure during childbirth [4]

Pregnancy, or very long labor, and postpartum bleeding is more common in cases of twin pregnancies or cases of excessive amniotic fluid (the fluid that surrounds the fetus),

Heavy bleeding after delivery may occur because the placenta or parts of it remain stuck in the uterus; it is considered primary bleeding for PPH. One of the leading causes that lead to bleeding after the end of the birth process and a significant reason for the increase in the mortality rate Pregnancy is a standard and natural state of affirmation of life, surrounded by hopes and joys; women should not perish while giving birth to their children; is demonstrated that such deaths are preventable, including in the poorest countries, but great efforts are needed, not only in medical care but also in government policies [5,6]

The World Health Organization (WHO) estimates deaths at 150,000 annual postpartum hemorrhage (PPH) in the Third World. PPH complicates 5-15% of all deliveries. It is the single most important cause of maternal mortality. Half of the PPHs are early and are generally the most acute and severe [7]

The causes of PPH are grouped into four categories: uterine atony, product retention of conception, trauma to the genital tract, and coagulation disorders. Uterine atony is the most common cause of PPH since it is involved in more than half of the cases and causes 4% of maternal deaths. The adherent placenta (placental accrete) occurs in 1 / 2,500 deliveries [8.9] However, it deserves a special mention for its severity and the upward trend of its frequency [10] On women with a placenta Previa and a uterus with one or more scars, the risk of placenta accretion can be equal to or greater than 25%. An active attitude during delivery has been shown to decrease the frequency of presentation of PPH by more than 40% [11-13]

Patient Sample

One hundred patients were collected from Al-karkh maternity hospital, Baghdad, Iraq, and Al-Hasena General Hospital, Karbala, Iraq, where the study was done retrospectively about blood loss.

Study Design

The incidence of primary postpartum hemorrhage in women treated prophylactically With carbetocin during cesarean section or vaginal delivery and was done by dividing patients into two categories or two sections, where the first section includes patients who did not receive carbetocin and the second section includes patients who received carbetocin in Where the results were analyzed depending on the amount of blood loss and the occurrence of bleeding after PPH after and during delivery, whether it was cesarean or vaginal.

Among the requirements were to obtain general information, age, gestational weeks, height, weight, period of delivery, and the postpartum period.

Paper requirements did not include women with high blood pressure or the presence of any heart disease.

Study Period

All results were analyzed from August 6, 2019, to January 1, 2020

Aim of Research

Evaluation of the efficacy and effects of Carbetocin on a postpartum hemorrhage.

Postpartum haemorrhage is the single most important cause of maternal death, and uterine atony is the most common cause. The best treatment is prevention. Carbetocin reduces the risk of PPH. In Iraq, carbetocin has been marketed, a human analog of oxytocin that has a rapid effect and an average life 4-10 times longer than oxytocin, producing a tonic contraction that reduces postpartum blood loss.

Statistical Analysis

All results were analyzed to evaluate the efficacy and effects of carbetocinin on postpartum hemorrhage through a statistical analysis program, SPSS SOFT 25:0 windows seven, where the complete regression was interpreted to the values. In addition to that, the actual value was found with the equivalent coefficient, without neglecting the comparison made between cesarean delivery and vaginal delivery through the reliance on Chi-square tests. The value p-value was found in the results.

1. Mean ±SD

2. Correlations 

3. Chi-square tests

4. P-value 

Table 1- Distribution of Patients by Type of Delivery

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FIG 1- Mean ±SD (Age) of Patient Vaginal Delivery

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FIG 2- Mean ±SD (Age) of Cesarean Patient Delivery

Table 2- Other Characteristics of Patient’s Vaginal Delivery

Table 3- Other Characteristics of Patient’s Cesarean Delivery

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FIG 3- P VALUE of Characteristics Patients’ Vaginal Delivery

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Fig 4- P-Value of Characteristics Patients’ Cesarean Delivery

Table 4- Blood Loss (Ml) Vaginal Delivery

Table 5- Blood Loss (ml) Cesarean Delivery

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Fig 5- P-Value of Blood Loss

The statistical analysis program showed that the average age of women was 33 years, and there was no reliance on a specific picture or pattern in the use of carbetocin. It was indicated that its use was present in 36% of all births. By reading previous studies, we find that our research was compatible. Relatively all studies demonstrated that the use of prophylactic carbetocin significantly reduced blood loss during CS, which was also reflected in the significant reduction in total blood loss.

The recommended dose for an adult woman is 100 micrograms administered slowly over a minute.

This systematic review of the use of postpartum Carbetocin to prevent bleeding, mainly due to uterine atony compared with other uterotonics, shows that in six of the eight studies, there were no differences in the primary outcomes (postpartum hemorrhage requiring additional uterotonics, drop in hemoglobin level at 24 and 48 hours postpartum, and postpartum hemorrhage greater than 500 ml),

Carbetocin acts as an agonist of peripheral oxytocin receptors, particularly in the myometrium, with less affinity for myoepithelial cells. The Oxytocin receptors are G protein-coupled, and their mechanism of action involves the action of second messengers and the production of inositol phosphates. Carbetocin mimics this mechanism. The binding for Carbetocin and other agonists of the Oxytocin is non-selective at the extracellular N-terminal and circuits E2 and E3. While the Oxytocin receptor shows an equal affinity for Oxytocin and Carbetocinin, the latter has an effect eight times longer than Oxytocin, requiring only a single dose.

Carbetocin inhibits the release of Oxytocin endogenous, interrupting the uterine feedback loop with the hypothalamus and the decrease of both the central and peripheral oxytocin. The synthesis of Oxytocin receptors in the uterus increases considerably during pregnancy, reaching a spike during childbirth. Consequently, the administration of Carbetocin during or immediately after birth will have an increased uterotonic and contractile effect.

The primary endpoint was post-cesarean hemorrhage >1000 ml in patients the first 24 hours. Secondary endpoints differed between studies but mainly included Postpartum hemorrhage and the need for a blood transfusion.

Carbetocin is a synthetic analog of oxytocin and has a more significant agonist effect Duration shows a security profile similar to or higher in some respects Oxytocin, with no evidence of side effects requiring alertness different or unique compared to oxytocin.

Carbetocin can be used to prevent vaginal bleeding after childbirth After a cesarean delivery. This uterotonic agent can be used in low and high-risk patients and elective and emergency cesarean sections.

Carbetocin shows benefit in terms of minimal use of agent’s Additional uterotonics in both elective and emergency cesarean sections and a significant reduction in the incidence of postpartum hemorrhage in cesarean section more than in vaginal deliveries.

 Postpartum hemorrhage associated with CS often leads to catastrophic problems and requires a complex approach to preserve the uterus.

• It is recommended to store the drug "Oxytocin" between a temperature of 2 to 8 degrees from the moment of manufacture until the moment of use.

• The researchers found that, in most cases, the drug was effective in preventing severe postpartum bleeding.

• The development of a drug that remains effective in the work environment in hot and humid weather conditions is "very good news for the millions of women who are giving birth in areas of the world where reliable refrigerants are difficult to from benefit.

The authors declare that they have no conflict of interest

The study was approved by the AL-karkh health office, Al-karkh maternity hospital, Baghdad, Iraq

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