CADTH RAPID RESPONSE REPORT: SUMMARY OF ABSTRACTS Carboprost for the Treatment of Postpartum Hemorrhage: Clinical Effectiveness, Cost- Effectiveness, and Guidelines
Service Line: Rapid Response Service Version: 1.0 Publication Date: November 5, 2018 Report Length: 6 Pages
Authors: Ke Xin Li, Lorna Adcock
Cite As: Carboprost for the treatment of postpartum hemorrhage: Clinical effectiveness, cost-effectiveness, and guidelines. Ottawa: CADTH; 2018 Nov. (CADTH rapid response report: summary of abstracts).
Acknowledgments:
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SUMMARY OF ABSTRACTS Carboprost for Postpartum Hemorrhage 2
Research Questions
1. What is the clinical effectiveness of carboprost in the treatment of postpartum hemorrhage?
2. What is the cost-effectiveness of carboprost for the treatment of postpartum hemorrhage?
3. What are the evidence-based guidelines associated with the use of carboprost for the treatment of postpartum hemorrhage?
Key Findings
One systematic review and two evidence-based guidelines were identified regarding the clinical effectiveness of carboprost for the treatment of postpartum hemorrhage. No economic evaluations were identified.
Methods
A limited literature search was conducted on key resources including PubMed, The Cochrane Library, University of York Centre for Reviews and Dissemination (CRD) databases, Canadian and major international health technology agencies, as well as a focused Internet search. No filters were applied to limit the retrieval by study type. Where possible, retrieval was limited to the human population. The search was also limited to English language documents published between January 1, 2013 and October 9, 2018. Internet links were provided, where available.
Selection Criteria
One reviewer screened citations and selected studies based on the inclusion criteria presented in Table 1.
Table 1: Selection Criteria Population Postpartum patients of any age experiencing primary (first 24 hours post-delivery) or secondary (24 hours to 12 weeks post-delivery) hemorrhage Intervention Carboprost (e.g., Hemabate) Comparators Q1-2: Usual care; Other interventions for postpartum hemorrhage (e.g., other medication, manual massage of the uterus, compression) Q3: No comparator Outcomes Q1: Acute clinical effectiveness and safety Q2: Cost-effectiveness Q3: Guidelines Study Designs Health technology assessments, systematic reviews, meta-analyses, randomized controlled trials, evidence-based guidelines
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Results
Rapid Response reports are organized so that the higher quality evidence is presented first. Therefore, health technology assessment reports, systematic reviews, and meta-analyses are presented first. These are followed by randomized controlled trials and evidence-based guidelines.
One systematic review, one randomized controlled trial, and two evidence-based guidelines were identified regarding the clinical effectiveness of carboprost for the treatment of postpartum hemorrhage. No relevant health technology assessments, meta-analyses, or randomized controlled trials studies were identified.
Additional references of potential interest are provided in the appendix.
Overall Summary of Findings
One systematic review1 and two evidence-based2,3 guidelines were identified regarding the clinical effectiveness of carboprost for the treatment of postpartum hemorrhage.
The systematic review by Agency for Healthcare Research and Quality (AHRQ) reported that there was insufficient strength of evidence regarding the use of carboprost tromethamine for bleeding control associated with postpartum hemorrhage.1 There was insufficient strength of evidence regarding harms associated with carboprost tromethamine intervention.1
The guideline by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) states that prostaglandin analogues including carboprost are the most potent uterotonics but have the most serious side effect profile which includes bronchospasm and hypertension.3 Recommendations associated with the administration of carboprost include one of two protocols: intra-muscular injection of 0.25mg in repeated doses as required at intervals of greater than or equal to 15 minutes with a maximum total cumulative dose of 2.0mg or intramyometrial injection of 0.5mg, which is not recommended by the manufactuer.3
The guideline by the National Institute for Health and Care Excellence (NICE) recommends repeated bolus doses of carboprost as one of the second-line agents for postpartum hemorrhage, along with oxytocin, ergometrine, and misoprostol.4 Further randomised controlled trials comparing carboprost with different agents are encouraged.4
References Summarized Health Technology Assessments
No literature identified
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Systematic Reviews and Meta-analyses
1. Likis, FE, Sathe, NA, Morgans, AK, Hartmann, KE, Young, JL, Carlson-Bremer, D, Schorn, M, Surawicz, T, Andrews, J. Management of postpartum hemorrhage. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). 2015. https://effectivehealthcare.ahrq.gov/topics/hemorrhage-postpartum/research Accessed 2018 Nov 2.
Randomized Controlled Trials
No literature identified
Guidelines and Recommendations
2. Management of postpartum haemorrhage (PPH). Victoria (AU): Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG); 2017: https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG- MEDIA/Women's%20Health/Statement%20and%20guidelines/Clinical- Obstetrics/Management-of-Postpartum-Haemorrhage-(C-Obs-43)-Review-July- 2017.pdf?ext=.pdf Accessed 2018 Nov 2.
3. Intrapartum care for healthy women and babies. London (GB): National Institute for Health and Care Excellence; 2014: https://www.nice.org.uk/guidance/cg190/resources/intrapartum-care-for-healthy-women- and-babies-pdf-35109866447557 Accessed 2018 Nov 2. See: Section 1.14.33, pages 69-70 Section 5 Postpartum Haemorrhage, page 86
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Appendix — Further Information Randomized Controlled Trials – Prophylactic Study
4. Sunil Kumar KS, Shyam S, Batakurki P. Carboprost versus oxytocin for active management of third stage of labor: A prospective randomized control study. J Obstet Gynaecol India. 2016 Oct;66(Suppl 1):229-234. PubMed: PM27651609
Clinical Practice Guidelines – Unspecified Methodology
5. Maternity and neonatal clinical guideline: Primary postpartum haemorrhage. Brisbane (AU): Queensland Health; 2018 https://www.health.qld.gov.au/__data/assets/pdf_file/0015/140136/g-pph.pdf Accessed 2018 Nov 2.
6. Evensen A, Anderson JM, Fontaine P. Postpartum hemorrhage: Prevention and treatment. Am Fam Physician 2017 Apr 1;95(7):442-229. https://www.aafp.org/afp/2017/0401/p442.html Accessed 2018 Nov 2.
7. SA Maternal & Neonatal Community of Practice. Prostaglandin analogues for major postpartum haemorrhage. Adelaide (AU): SA Health; 2016: https://www.sahealth.sa.gov.au/wps/wcm/connect/c0ba55804d606080a55ce578e28879 6e/prostaglandin+analogues+for+major+postpartum+haemorrhage_27042016.pdf?MO D=AJPERES&CACHEID=ROOTWORKSPACE- c0ba55804d606080a55ce578e288796e-lYywM2g Accessed 2018 Nov 2.
8. Postpartum haemorrhage (PPH) prevention and management. Auckland (AU): Auckland District Health Board; 2015: http://nationalwomenshealth.adhb.govt.nz/Portals/0/Documents/Policies/Postpartum%2 0Haemorrhage%20(PPH)%20Prevention%20and%20Management_.pdf Accessed 2018 Nov 2.
9. Postpartum hemorrhage management. Vancouver (BC): BC Women’s Hospital & Health Centre; 2013. http://policyandorders.cw.bc.ca/resource- gallery/Documents/BC%20Women%27s%20Hospital%20- %20Fetal%20Maternal%20Newborn/WW.08.16%20Postpartum%20Hemorrhage%20M anagement.pdf Accessed 2018 Nov 2.
Review Articles
10. Sumikura H, Inada E. Uterotonics and tocolytics for anesthesiologists. Curr Opin Anaesthesiol. 2016 Jun;29(3):282-287.PubMed: PM26974052
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