Evidence map›Paper›PMID 40345687›Full record

ArticleBMJ open2025

Carboprost versus Oxytocin as the first-line treatment of primary postpartum haemorrhage (COPE): protocol for a phase IV, double-blind, double-dummy, randomised controlled trial and economic analysis.

Charlotte Van Netten, Kirtana Vallabhaneni, Ben Hardwick, Dilly Anumba, Annette L Briley, Peter Collins, Rachel E Collis, Elizabeth Deja, Efstathia Gkioni, Gillian Gyte and 17 more

Abstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

27 authors.

Charlotte Van NettenLiverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.ORCID http://orcid.org/0009-0002-2743-4637
Kirtana VallabhaneniDepartment of Women's and Children's Health, University of Liverpool, Liverpool, UK.
Ben HardwickLiverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.
Dilly AnumbaSchool of Medicine & Population Health, The University of Sheffield, Sheffield, UK.
Annette L BrileyCaring Futures Institute, Flinders University, Bedford Park, South Australia, Australia.
Peter CollinsInstitute of Infection and Immunity, Cardiff University, Cardiff, UK.
Rachel E CollisUniversity Hospital of Wales, Cardiff, UK.
Elizabeth DejaDepartment of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
Efstathia GkioniLiverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.
Gillian GyteNational Childbirth Trust, London, UK.
Helen HickeyLiverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.
Kim HinshawObstetrics and Gynaecology, Sunderland Royal Hospital, Sunderland, UK.
Dyfrig A HughesCentre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK.ORCID http://orcid.org/0000-0001-8247-7459
Sion KenyonLiverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.
Tina LavenderDepartment of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.ORCID http://orcid.org/0000-0003-1473-4956
Shireen MeherNepean Clinical School, University of Sydney, Kingswood, New South Wales, Australia.
Catrin PlumptonCentre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK.
Stephen RobsonNewcastle University, Newcastle upon Tyne, UK.
Anna Rosala-HallasLiverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.
Egle SaviciuteLiverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.
Andrew ShennanDepartment of Women's and Children's Health, King's College London, London, UK.
Dimitrios SiassakosInstitute for Women's Health, University College London, London, UK.
Jim ThorntonObstetrics & Gynaecology, University of Nottingham, Nottingham, UK.ORCID http://orcid.org/0000-0001-9764-6876
Elaine WillisLiverpool Women's Hospital NHS Foundation Trust, Liverpool, UK.
Kerry WoolfallDepartment of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
Carrol GambleLiverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.
Andrew WeeksDepartment of Women's and Children's Health, University of Liverpool, Liverpool, UK aweeks@liverpool.ac.uk.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionExcessive bleeding after childbirth (postpartum haemorrhage, PPH) affects 5% of births and causes 75 000 maternal deaths worldwide annually. It is the leading cause of direct maternal deaths globally and continues to be a major cause of mortality in the UK. Oxytocin is the standard first-line treatment for atonic PPH. The PPH rate is increasing, and this may be partially related to the overuse of oxytocics in labour. Laboratory studies on myometrium suggest that repeated use of oxytocics leads to the saturation of oxytocin receptors and reduced therapeutic efficacy of oxytocin. Carboprost (a prostaglandin analogue) is usually reserved for second-line management of atonic PPH. A systematic review comparing the efficacy of carboprost and conventional uterotonics for PPH prophylaxis found that carboprost was associated with less blood loss, but around 15% of women experienced side effects. The study's aim is to compare intramuscular carboprost with intravenous oxytocin for the initial treatment of PPH. In addition, to assess the cost-effectiveness of both treatments, participants' views on the two treatments and the consent process. METHODS AND ANALYSIS: COPE is a double-blind, double-dummy, randomised controlled trial that aims to recruit 2000 women (1:1 allocation, stratified by mode of birth) across 20 hospitals in the UK. Due to the emergency nature of PPH, COPE uses a research without prior consent (RWPC) model. Randomisation and treatment will occur if eligibility criteria are met once bleeding starts. Postnatal consent will be sought for disclosure of identifiable data and continued follow-up. Clinical efficacy outcomes will be collected at 24 and 48 hours or at hospital discharge, if sooner. Questionnaires will also be collected at 24 hours and 4 weeks postrandomisation. Cost-effectiveness will be based on the incremental cost per quality-adjusted life-year, calculated from the perspective of the NHS and personal social services. ETHICS AND DISSEMINATION: This study has been approved by the Coventry and Warwickshire Research Ethics Committee (REC) (18/WM/0227) and the Health Research Authority. Results will be disseminated via peer-reviewed publications. TRIAL REGISTRATION NUMBER: ISRCTN16416766.

Indexed as

CarboprostOxytocicsOxytocinPostpartum HemorrhageClinical Trials, Phase IV as TopicCost-Benefit AnalysisDouble-Blind MethodFemaleHumansPregnancyRandomized Controlled Trials as TopicUnited KingdomCarboprostOxytocicsOxytocinHEALTH ECONOMICSMaternal medicinePostpartum WomenPregnancyQUALITATIVE RESEARCHRandomized Controlled Trial

Identifiers

PMID40345687
PMCPMC12067827

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.