Carbetocin Tablet

Postpartum hemorrhage is one of the most common and severe complications after vaginal delivery, defined as blood loss ≥500 mL within 24 hours postpartum. Its primary cause is inadequate uterus contraction - the inability of uterus smooth muscle to contract effectively after delivery, which prevents the compression and closure of blood vessels within the myometrium, leading to hemorrhage. In severe cases, it can result in hemorrhagic shock, disseminated intravascular coagulation, and even life-threatening conditions for parturients. According to the World Health Organization, postpartum hemorrhage is the leading cause of maternal mortality worldwide, causing over 70,000 deaths annually, 99% of which occur in low- and middle-income countries. As a potent uterotonic agent, Carbetocin Tablet acts by mimicking natural atonino to target inadequate contraction of the uterus. It effectively prevents postpartum hemorrhage after vaginal delivery and provides timely treatment for established bleeding, serving as a key drug in the prevention and management of postpartum hemorrhage.

In the prevention of postpartum hemorrhage after vaginal delivery, it is indicated for parturients at high risk of hemorrhage and can also be used as a routine prophylactic agent for general parturients. It is particularly suitable for primary medical institutions or regions with inadequate cold-chain facilities. The core objective of its prophylactic use is to promptly initiate contraction of the uterus following fetal delivery, prevent uterous atony, and reduce the risk of hemorrhage at the source.

Clinical studies have demonstrated that the efficacy of pabal in preventing postpartum hemorrhage after vaginal delivery is non-inferior to conventional atonino, with superior safety and convenience. A study including 11 randomized controlled trials and 2,635 parturients showed that, compared with atonino, pabal for postpartum hemorrhage prophylaxis after vaginal delivery was associated with less blood loss and significantly lower incidences of adverse reactions such as nausea, vomiting, and hypertension. Another meta-analysis of multiple randomized controlled trials comparing pabal and atonino for postpartum hemorrhage prophylaxis after vaginal delivery revealed that the pabal group had a significantly lower rate of postpartum hemorrhage (blood loss ≥500 mL) (OR=0.62, 95%CI: 0.46–0.84, P=0.002) and a markedly reduced proportion requiring additional uterotonic agents (OR=0.41, 95%CI: 0.29–0.56, P<0.00001).There was no significant difference in transfusion requirements between the two groups, confirming that pabal is superior to atonino in preventing postpartum hemorrhage after vaginal delivery and can be widely applied in clinical practice.

It provides more pronounced prophylactic effects in parturients with high risk factors for postpartum hemorrhage, including multiple pregnancy, polyhydramnios, macrosomia, multiparity, and excessive stretching of uterous myofibers. Due to excessive myometrial load, these parturients face a higher risk of uterous atony after delivery; routine oral administration of it effectively enhances uterous contraction and reduces hemorrhage risk. In addition, the thermostable formulation of pabal can be stored for up to 3 years at ≤30°C without cold-chain storage, solving the problem of conventional atonino degradation in regions with unstable power supply and weak cold-chain infrastructure. This makes it more suitable for promotion in low- and middle-income countries and grassroots areas, further expanding the coverage of postpartum hemorrhage prevention.

When inadequate uterous contraction and increased bleeding occur after vaginal delivery, Carbetocin Tablet can be used as a uterotonic agent for hemostatic therapy to rapidly relieve bleeding symptoms and prevent disease progression. The key to its therapeutic application is timely drug administration to strengthen uterous contraction, compress bleeding vessels, and achieve hemostasis.

In clinical practice, for parturients with postpartum blood loss exceeding 500 mL and uterous atony (soft uterous texture, unclear uterous contour) after vaginal delivery, pabal tablet can be administered orally immediately after excluding other causes of hemorrhage such as placental retention, birth canal trauma, and coagulation disorders.Physical measures such as uterous massage can be combined to enhance hemostatic efficacy.

Studies show that oral pabal is rapidly absorbed, inducing significant uterous contraction within 2 minutes and maintaining effective uterous tone for 1 hour, enabling rapid reduction of blood loss and alleviation of uterous atony.Compared with other oral uterotonic agents, it have a longer duration of action, eliminating the need for frequent dosing, reducing the workload of medical staff, and improving patient compliance.

Notably, if uterous contraction remains inadequate and bleeding is uncontrolled after a single oral dose of it, repeated administration is not recommended. Alternative uterotonic agents (e.g., atonino, ergometrine) or other hemostatic measures such as uterous packing and arterial embolization should be promptly adopted, with further investigation into the cause of hemorrhage to avoid delayed treatment. In addition, for parturients with severe hemorrhage, concomitant use of the product should be accompanied by timely blood volume replacement, correction of anemia, and blood transfusion when necessary to ensure maternal safety.

Induced abortion (including vacuum aspiration and medical abortion) and uterous curettage are common gynecological and obstetric procedures, mainly used for terminating early pregnancy and removing residual intrauterine tissues (e.g., incomplete medical abortion, postpartum placental retention). These procedures cause certain damage to the uterous mucosa, and the uterus requires contraction to gradually return to its non-pregnant state (i.e., uterous involution). Poor uterous involution leads to uterous atony, resulting in intrauterine hematoma, prolonged vaginal bleeding, increased blood loss, and even elevated risks of complications such as intrauterine infection and intrauterine adhesions, impairing patients' reproductive health.

As a long-acting uterotonic agent, it effectively promotes uterous contraction after induced abortion/uterous curettage, accelerates uterous involution, reduces intrauterine hematoma, shortens vaginal bleeding duration, and lowers complication risks, serving as an important adjuvant drug for postoperative treatment.

(II) Application in Promoting Uterine Involution

Uterous involution is a vital physiological process after induced abortion/uterous curettage, typically requiring 2–4 weeks. Poor uterous involution manifests as enlarged uterous volume, soft uterous texture, prolonged vaginal bleeding (exceeding 2 weeks), and increased blood loss, which may lead to anemia and intrauterine infection in severe cases. Carbetocin Tablet enhances uterous contraction to accelerate uterous involution and restore the uterus to its non-pregnant state as soon as possible.

Clinical studies indicate that routine oral administration of it after induced abortion/uterous curettage significantly shortens uterous involution time, reduces uterous volume, and improves uterous contractile function. For patients with poor uterous involution after medical abortion, oral pabal tablets effectively strengthen uterous contraction, promote uterous volume reduction, and shorten vaginal bleeding duration. Compared with patients not receiving uterotonic agents, the rate of satisfactory uterous involution is significantly increased, and the incidence of complications is markedly reduced.

Furthermore, pabal facilitates endometrial repair and reduces the risk of intrauterine adhesions, safeguarding patients' subsequent reproductive health.

In clinical practice, oral administration of pabal tablet is generally recommended within 24 hours after induced abortion/uterous curettage, for a continuous course of 3–5 days. The specific dosage is adjusted by physicians based on the patient's condition and blood loss. For patients with severe poor uterous involution, the treatment duration may be appropriately prolonged, and combined use with Chinese patent medicines such as Leonurus japonicus can further enhance uterous involution.

Intrauterine hematoma is a common complication after induced abortion/uterous curettage, mainly caused by postoperative uterous atony that prevents timely discharge of intrauterine blood accumulation. It presents as persistent vaginal bleeding, abdominal pain, and lumbosacral soreness; massive hematoma may lead to intrauterine infection and fever. Pabal tablet stimulates uterous contraction to effectively promote the discharge of intrauterine hematoma, reduce its incidence, and relieve discomforts such as abdominal pain and lumbosacral soreness caused by hematoma.

In clinical practice, oral administration of pabal tablet significantly reduces the incidence of intrauterine hematoma in patients at risk after induced abortion/uterous curettage (e.g., excessive postoperative blood loss, uterine atony, small residual intrauterine tissues).

A clinical observation showed that the incidence of intrauterine hematoma was approximately 5% in patients taking pabal tablets postoperatively, compared with over 20% in those not receiving uterotonic agents. Moreover, patients taking it had smaller hematoma volumes, faster absorption or discharge, and a significantly higher rate of avoiding repeat curettage.

Notably, if postoperative intrauterine hematoma is excessive (>100 mL) or unabsorbed/un-discharged after pabal tablet administration, B-ultrasound examination should be performed promptly to assess the hematoma, and uterous curettage may be necessary to remove hematoma and residual tissues to prevent aggravated complications. Meanwhile, postoperative rest, avoidance of fatigue, and appropriate activity are advised to promote hematoma discharge, combined with oral antibiotics for infection prophylaxis.