Comparative Efficacy of Carbetocin and Oxytocin in Parturients at Risk of Atonic Postpartum Hemorrhage Undergoing Elective Cesarean Delivery: a Randomized Controlled Trial

The goal of this study is to compare 2 medications that are commonly used to prevent excess uterine bleeding (postpartum hemorrhage, or PPH) following cesarean delivery (CD), oxytocin and carbetocin. Most of the trials evaluating the preventative role of oxytocin and carbetocin after CD have focused on patient with low-risk of PPH.
This trial will focus on patients that are at increased risk of PPH, with risk factors such as: multiple gestation (twins, or more multiples), large baby, polyhydramnios (excess amniotic fluid), history of PPH, body mass index greater than 40, diabetes mellitus, hypertension, and placenta previa.
The investigators hypothesize that carbetocin would be more effective than an oxytocin regimen in reducing the risk of PPH in patients undergoing CD with any of the biological high-risk factors.

Start Date01 Nov 2024

Sponsor / Collaborator

Samuel Lunenfeld Research Institute

NCT06692621

/ RecruitingNot ApplicableIIT

Effects of Carbetocin and Oxytocin Used in Cesarean Sections on Postoperative Pain

The aim of this observational study is to compare postoperative analgesic consumption in patients who received peroperative carbetocin or oxytocin. The main question it aims to answer is:
. Does peroperative carbetocin use reduce postoperative analgesic consumption compared to oxytocin?
Patients who receive routine uterotonic agents in caesarean section surgeries will be divided into two groups and their postoperative 24-hour analgesic consumption will be compared.

Start Date04 Oct 2024

Sponsor / Collaborator

Ankara Bilkent City Hospital

TCTR20241030008

/ CompletedNot ApplicableIIT

Comparing the effectiveness of Carbetocin and Oxytocin in preventing postpartum hemorrhage in preeclampsia

Start Date01 Oct 2024

Sponsor / Collaborator-

100 Clinical Results associated with Carbetocin

100 Translational Medicine associated with Carbetocin

100 Patents (Medical) associated with Carbetocin

323

Literatures (Medical) associated with Carbetocin

01 Feb 2025·European Journal of Obstetrics & Gynecology and Reproductive Biology

Shock index reference ranges in the first 48 h postpartum following elective cesarean delivery: A prospective cohort study

Article

Author: Kayikci, Umutcan ; Sinci, Umut ; Yulek, Zeynep ; Cagan, Murat ; Deren, Ozgur ; Bayrak, Ayse Cigdem ; Fadiloglu, Erdem

PURPOSETo determine the reference values for the shock index (SI) in postpartum patients undergoing elective cesarean delivery with regional anesthesia.METHODSThis prospective study was conducted at our tertiary center between August 1, 2023, and March 1, 2024. We calculated the reference values for the SI within the first 48 h postpartum for patients who underwent elective cesarean delivery after the 34th week of gestation. We excluded cases of vaginal delivery, post-term delivery (≥42 weeks of gestation), multiple pregnancies, stillbirths, fetal abnormalities, maternal cardiac disease, anemia, untreated hypo- or hyperthyroidism, and any hypertensive disorders diagnosed before or during pregnancy. Data collection, measurement of vital signs, and the administration of fluids pre-, intra-, and post-operatively, as well as the use and dosing of uterotonic agents for the prevention of postpartum hemorrhage (PPH), were standardized for all patients.RESULTSOur final analysis included 311 patients, with a mean SI value of approximately 0.7 (0.67-0.77) for all measurement performed within the first 48 h of the postpartum period. Further analyses revealed that the 90th and 95th percentiles of SI were around 0.9 throughout the study period. Additionally, SI reference values analyzed at different time points were consistent. Our analysis demonstrated that SI values were not influenced by the presence of a previous caesarean section, the administration of oxytocin or carbetocin, or parity in this particular cohort. Our analyses of vital signs also indicated that the 95th percentile of heart rate (HR) ranged from 96 to 100 bpm.DISCUSSIONAn SI value of 0.9 represents the 95th percentile of SI values throughout the first 48 h of the postpartum period. Any greater value should be evaluated carefully for potential adverse outcomes.

15 Jan 2025·The Journal of Maternal-Fetal & Neonatal MedicineQ4 · MEDICINE

Effect of heat stable carbetocin vs oxytocin for preventing postpartum haemorrhage on post delivery hemoglobin–a randomized controlled trial.

Q4 · MEDICINE

Article

Author: Somannavar, Manjunath S. ; Vernekar, Sunil S. ; Pujar, Yeshita V. ; Carvalho, José Ferreira D. E. ; Goudar, Swati S. ; Gulmezoglu, Ahmet Metin ; Goudar, Shivaprasad S. ; Widmer, Mariana ; Metgud, Mrityunjay ; Piaggio, Gilda ; Revankar, Amit ; Althabe, Fernando

OBJECTIVETo compare the effect of heat-stable carbetocin 100 μg IM versus oxytocin 10 IU IM on post-delivery hemoglobin level.SETTINGHospital based study in Southern India.POPULATIONWomen delivering vaginally who were enrolled in the WHO CHAMPION trial in a single facility in India. WHO CHAMPION Trial was a randomized, double-blind, noninferiority trial comparing intramuscular injections of heat-stable carbetocin with oxytocin administered immediately after vaginal birth in women across 23 sites in 10 countries.METHODSThis was a nested randomized controlled trial designed to compare the effect of heat-stable carbetocin 100 μg IM versus oxytocin 10 IU IM, administered within one minute of vaginal delivery of the baby for prevention of postpartum hemorrhage, on post-delivery 48-72 h hemoglobin level, adjusted for pre-delivery hemoglobin level. 1,799 women from one hospital in India participated in this study.RESULTSPre-delivery hemoglobin and postpartum blood loss were not significantly different between carbetocin and oxytocin. Post-delivery hemoglobin, unadjusted or adjusted for pre-delivery hemoglobin, was slightly lower for carbetocin (10.09 g/dL) compared to oxytocin (10.21) (p value of 0.0432). The drop in hemoglobin was slightly higher for carbetocin, although the difference was very small (1.2 g/dL for carbetocin, 1.1 g/dL for oxytocin) (p value of .0786). The proportion of participants with a drop in hemoglobin of 2 g/dL or more, adjusted for pre-delivery hemoglobin, was higher for carbetocin (RR = 1.29, 95% CI 1.02-1.63). From the regression coefficients it can be derived that post-delivery hemoglobin, adjusted for pre-delivery hemoglobin, decreases on average 0.12 g/dL for each dL of blood lost, for the two treatments combined.CONCLUSIONThe present ancillary study showed that intramuscular administration of 100 µg of heat stable carbetocin can result in a slightly lower post-delivery hemoglobin, slightly higher drop and higher percentage of women having a drop of 2 g/dL or larger, compared to 10 IU of oxytocin.

15 Jan 2025·The Journal of Maternal-Fetal & Neonatal MedicineQ4 · MEDICINE

Carbetocin for the prevention of post-partum hemorrhage after vaginal birth: a real-world application

Q4 · MEDICINE

Article

Author: Baud, David ; Desseauve, David ; Sichitiu, Joanna

OBJECTIVETo compare maternal outcomes using Carbetocin versus Oxytocin for the active management of the third stage of labor, given a temporary national shortage of Oxytocin.METHODSWe conducted a retrospective observational study on a cohort of 866 women with vaginal deliveries at our center, >36 weeks of gestation, between November 2018 and March 2019. During the shortage period, each woman received a single slow intravenous injection of Carbetocin 100 µg at delivery of the anterior shoulder, rather than Oxytocin 5 UI, as postpartum hemorrhage prophylaxis. 146 (16.9%) patients received Carbetocin versus 720 (83.1%) receiving Oxytocin. The outcomes were rates of postpartum hemorrhage, severe postpartum hemorrhage, and placental retention.RESULTSIncidence rates of placental retention and postpartum hemorrhage were 4.9% and 9.4% respectively. Placenta retention was significantly more likely following Carbetocin administration (adjusted odds ratio 2.5; 95% confidence interval 1.2-5.0). Postpartum hemorrhage rates were not significantly different (adjusted odds ratio 1.1; 95% confidence interval 0.6-2.1), as were severe postpartum hemorrhage rates (adjusted odds ratio 0.7; 95% confidence interval 0.2-2.2).CONCLUSIONCarbetocin is as effective as Oxytocin for postpartum hemorrhage prevention. However, we would reserve it for use after placental delivery due to the increased retention rates.

News (Medical) associated with Carbetocin

14 Jan 2025

·www.businesswire.com

Acadia Pharmaceuticals Provides Business and Pipeline Updates at 43rd Annual J.P. Morgan Healthcare Conference

SAN DIEGO--( BUSINESS WIRE )--Acadia Pharmaceuticals Inc. (Nasdaq: ACAD) today announced multiple business updates and progress on the Company's CNS and rare disease drug candidates, which will be discussed today during a presentation by Catherine Owen Adams, Chief Executive Officer, at the 43rd Annual J.P. Morgan Healthcare Conference in San Francisco, CA. “ 2025 is shaping up to be an exciting year as we build on the success of our two growing brands, NUPLAZID and DAYBUE, which together are projected to generate more than $1 billion in net sales this year,” said Catherine Owen Adams, Chief Executive Officer. “ In addition to growing our strong commercial franchises, we are laying the foundation for future growth through global expansion and pipeline advancement. Today, we announced our submission of a marketing authorization application for DAYBUE with the European Medicines Agency and anticipate beginning Managed Access Program–related sales in Europe as early as the second quarter. We are also pleased to share updates on our R&D pipeline—both today and at our first R&D Day in mid-2025—as our lead programs near data readouts. By expanding our reach beyond the U.S. and continuing to advance our pipeline, we believe Acadia is poised for sustained top-line growth and increasing positive cash flow.” Key 2025-2026 Milestones: Announced today that the marketing authorization application for DAYBUE ™ has been submitted to the European Medicines Agency (EMA) with expected approval in the first quarter of 2026. Initiation of Managed Access Programs in Europe in the second quarter of 2025, potentially resulting in the Company’s first revenues from outside the U.S. Enrollment of the last patient in the COMPASS PWS Phase 3 study of ACP-101 in Prader-Willi Syndrome anticipated in the fourth quarter of 2025, followed by top-line results announcement in the first half of 2026. Enrollment of the last patient in the RADIANT Phase 2 study of ACP-204 in Alzheimer’s disease psychosis expected in the first quarter of 2026, followed by top-line results announcement in mid-2026. Initiation of a Phase 2 study of ACP-204 for a second indication in Lewy Body Dementia in the third quarter of 2025. The Company will host its first ever R&D Day in mid-2025. Annual net sales for the full-year 2025 expected to exceed $1 billion for the first time in Company history. Today’s presentation will take place at 9:00 a.m. Pacific Time / 12:00 p.m. Eastern Time. A live webcast of the presentation will be accessible on the Company’s website, Acadia.com, under the investors section and an archived recording will be available on the website for approximately one month following the presentation. About Acadia Pharmaceuticals Acadia is advancing breakthroughs in neuroscience to elevate life. Since our founding we have been working at the forefront of healthcare to bring vital solutions to people who need them most. We developed and commercialized the first and only FDA-approved drug to treat hallucinations and delusions associated with Parkinson’s disease psychosis and the first and only approved drug in the United States and Canada for the treatment of Rett syndrome. Our clinical-stage development efforts are focused on Prader-Willi syndrome, Alzheimer’s disease psychosis and multiple other programs targeting neuropsychiatric symptoms in central nervous system disorders. For more information, visit us at Acadia.com and follow us on LinkedIn and X . Forward-Looking Statements This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements include all statements other than statements of historical fact and can be identified by terms such as “may,” “will,” “should,” “could,” “would,” “expects,” “plans,” “anticipates,” “believes,” “estimates,” “projects,” “predicts,” “potential,” “continue” and similar expressions (including the negative thereof) intended to identify forward-looking statements. Forward-looking statements contained in this press release, include, but are not limited to, statements about: (i) our business strategy, objectives and opportunities, including support for and innovations in our pipeline assets and business development opportunities, and potential for enhanced shareholder value; (ii) plans for, including timing, development and progress of commercialization, and expected regulatory timelines for trofinetide in the EU; (iii) plans for our pipeline, including the timing and conduct of our clinical trials, anticipated enrollment milestones and the timing and results of data from our clinical trials; and (iv) our estimates regarding our future financial performance, profitability and capital requirements, including our full year 2024 financial guidance and potential achievement of our milestone of annualized net sales in 2025. Forward-looking statements are subject to known and unknown risks, uncertainties, assumptions and other factors that may cause our actual results, performance or achievements to differ materially and adversely from those anticipated or implied by our forward-looking statements. Such risks, uncertainties and other factors include, but are not limited to: our dependency on the continued successful commercialization of NUPLAZID ® and DAYBUE and our ability to maintain or increase sales of NUPLAZID or DAYBUE; our plans to commercialize DAYBUE outside the U.S., including in Canada; the costs of our commercialization plans and development programs, and the financial impact or revenues from any commercialization we undertake; our ability to obtain necessary regulatory approvals for our product candidates and, if and when approved, market acceptance of our products; the risks associated with clinical trials and their outcomes, including risks of unsuccessful enrollment and negative or inconsistent results; our dependence on third-party collaborators, clinical research organizations, manufacturers, suppliers and distributors; the impact of competitive products and therapies; our ability to generate or obtain the necessary capital to fund our operations; our ability to grow, equip and train our specialized sales forces; our ability to manage the growth and complexity of our organization; our ability to maintain, protect and enhance our intellectual property; and our ability to continue to stay in compliance with applicable laws and regulations. Given the risks and uncertainties, you should not place undue reliance on these forward-looking statements. For a discussion of these and other risks, uncertainties and other factors that may cause our actual results, performance or achievements to differ, please refer to our quarterly report on Form 10-Q quarter ended September 30, 2024, filed with the SEC on November 7, 2024, available at www.sec.gov . The forward-looking statements contained herein are made as of the date hereof, and we undertake no obligation to update them after this date, except as required by law.

Phase 3Drug ApprovalPhase 2

17 Dec 2024

·www.biopharmadive.com

Maternal mortality trends are dire — and reversing them remain an uphill battle

Maternal mortality in the U.S. has been on the rise, with the rate per 100,000 live births more than doubling from the first decade of the 2000s to the second.Health equity remains a major piece of the puzzle. As of 2022, Black women were more than twice as likely to die from a pregnancy-related condition than women of other racial backgrounds. This highlights shortcomings in access to care, but also points to the general lack of research in the field, said A. Metin Glmezoglu, executive director at the nonprofit Concept Foundation, which leads a project called Accelerating Innovation for Mothers.There have been very few new medicines being registered for these pregnancy conditions in the last 30 to 40 years, Glmezoglu said. If you compare this to innovations in other areas like chronic diseases, it's really tiny in terms of the number of solutions we have.The slow pace of innovation can be traced back to two major mid-20th century tragedies related to prescription drugs the nausea medicine thalidomide for pregnant women led to severe birth defects in thousands of children in the 1950s and 1960s and, not long after that, the hormone diethylstilbestrol was found to cause cancer in women who had been exposed to it in utero.These developments chilled drug research involving pregnant women. But in a twist of fate, what was meant to protect women and their children made it harder to find new drugs for them, Glmezoglu said, driving up mortality rates.These tragedies created this enormous fear and risk averseness in this area because those two drugs were not actually researched properly without a rigorous evaluation before, Glmezoglu said. That created this mindset that pregnant women are vulnerable and we have to protect the fetus, even if it means we have to withhold medication a woman might need.The research shortcomings are global, but they have a greater impact among women in low- and middle-income countries, where clinical research is less, Glmezoglu said.Other challenges include the limited time period of pregnancy, which makes drug testing more difficult. All of these combine for a perfect storm where nobody's investing in this field, he added.A gendered problemWhen women take part in clinical research and become pregnant, they are often taken out of that trial, Glmezoglu said, further thinning the data that becomes available.All of these differences tend to push evaluation to male bodies, male cell cultures and so on, which in the short term may be helpful because you can find solutions easier, but it doesn't help because you are not developing solutions for the other 50% of the population, Glmezoglu said.This was made clear during the COVID-19 pandemic, when vaccine trials excluded pregnant women, even though they were at higher risk of mortality and morbidity from the virus. That shifted the responsibility to healthcare providers and patients to decide whether to receive a shot.Gaining traction for a widespread push to study women's health issues more could partly hinge on winning political and public support.Inclusion of women and inclusion of pregnant and lactating women in trials has for many years been a secondary concern, Glmezoglu said. Any political process that does not support inclusivity and equality is likely to have an adverse effect on women's inclusion in research as a general concern.Mercks effortsJacquelyn Caglia, director of learning, communications and U.S. programs, Merck for MothersPermission granted by Merck for MothersOne success story came out of pharmaceutical giant Merck & Co. in 2018, which through its Merck for Mothers initiative studied the use of heat-stable carbetocin, finding it was not inferior to the standard of care oxytocin at preventing excessive bleeding after birth. The heat-stable nature of the new compound makes it easier to use in countries where refrigeration is difficult to come by.Merck for Mothers has been building evidence for maternal mortality trends since 2011 and providing women with education and health solutions in the U.S., India, Kenya and Nigeria. The initiative has reached more than 30 million women in that time, said Jacquelyn Caglia, director of learning, communications and U.S. programs at Merck for Mothers.Caglias vision is to see a healthcare system with a plan in place to treat mothers in the same way it treats newborns.What are our opportunities to think about mom and baby receiving care together? Our system across the U.S. is not quite set up that way, Caglia said. We have a very clear schedule for the types of care and visits and the timing of those visits that newborns need to have but what's our opportunity to think about mom and the care that they should be receiving alongside the newborn at those same points in time?Through programs like the Safer Childbirth Cities which supports community organizations in cities with high maternal mortality rates Merck for Mothers aims to meet mothers where they are, reducing geographic disparities that cause gaps in outcomes.We're still seeing in our national trends across the U.S. and globally, that most of the deaths, most of the complications, are preventable, which points us in the direction of where we need to intervene, Caglia said. There are continued patterns of differences based on race and ethnicity as well as based on geography ... and those disparities demand our attention. '

Vaccine

06 Nov 2024

·firstwordpharma.com

Acadia pockets $100M from paediatric voucher sale

After scoring the first FDA approval for a Rett syndrome treatment last year, Acadia Pharmaceuticals has now sold the rare paediatric disease priority review voucher it gained along with the greenlight. Daybue (trofinetide), an analogue of the neuropeptide IGF-1, was cleared to treat adult and paediatric patients two years and older with the rare genetic disorder.Acadia said the voucher sold for $150 million, but did not disclose the buyer. The drug developer will only profit $100 million off the sale, however, as Neuren Pharmaceuticals — from whom Acadia gained North American rights for Daybue — is entitled to one-third, or $50 million, of the proceeds. The funds will be invested into Acadia's commercial efforts, as well as its R&D work in central nervous system disorders and rare diseases.In addition to Daybue, the firm markets one other drug — Nuplazid (pimavanserin) for Parkinson’s disease psychosis.The company's pipeline features three clinical assets, and several undisclosed programmes in preclinical development. The most advanced, ACP-101, is in Phase III testing for hyperphagia in Prader-Willi syndrome. The next, ACP-204, is in Phase II testing for Alzheimer's disease psychosis, and Acadia has exclusive, worldwide rights to Phase I-stage candidate ACP-2591 for Rett and fragile X syndromes from Neuren. In March, Acadia's attempt to expand Nuplazid's label beyond psychosis and into schizophrenia crumbled after the inverse serotonin 5-HT2A receptor agonist failed a Phase III study.

Phase 3Phase 2Priority ReviewDrug Approval

100 Deals associated with Carbetocin

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KEGG	Wiki	ATC	Drug Bank
D07229	Carbetocin	H01BB03	DB01282

R&D Status

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Indication	Country/Location	Organization	Date
Uterine Inertia	AU	Ferring Pharmaceuticals Pty Ltd.	17 Apr 2015
Hemorrhage	-	-	-

Developing

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Indication	Highest Phase	Country/Location	Organization	Date
Hyperphagia	Phase 3	CA	ACADIA Pharmaceuticals, Inc.	27 Nov 2023
Hyperphagia	Phase 3	GB	ACADIA Pharmaceuticals, Inc.	27 Nov 2023
Hyperphagia	Phase 3	US	ACADIA Pharmaceuticals, Inc.	27 Nov 2023
Prader-Willi Syndrome	Phase 1	AU	Levo Therapeutics, Inc.Startup	20 Nov 2018
Postpartum Hemorrhage	Phase 1	GB	Ferring Pharmaceuticals A/S	01 Feb 2015

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Study	Phase	Population	Analyzed Enrollment	Group	Results	Evaluation	Publication Date


NCT04902729 (Pubmed \| Can J Anaesth)	Not Applicable	-	-	Oxytocin 1 IU iv	rxzqizgqld(rehshvzxoi) = vohvyeiqit kdgiafqnth (ictuukflvn, 7 - 8)	Positive	06 Jan 2025
				Carbetocin 80 µg iv	rxzqizgqld(rehshvzxoi) = iquvtsizey kdgiafqnth (ictuukflvn, 8 - 9)
NCT03649477 (CARE-PWS, CTgov)	Phase 3	Prader-Willi Syndrome	130	9.6 mg intranasal carbetocin (9.6 mg of LV-101)	lcrjnssqml(hbtmcfpfxo) = bqfhrnxgjd satyeddjnj (jkhifgwehy, xatabqdqkf - qjpmagdcjz) View more	-	17 Nov 2021
				3.2 mg intranasal carbetocin (3.2 mg of LV-101)	lcrjnssqml(hbtmcfpfxo) = rnpchyqlty satyeddjnj (jkhifgwehy, yucfsvgtzi - hqlzdywbbp) View more
NCT03716076 (CaRDIO, CTgov)	Phase 4	Arrhythmia, Sinus	50	Carbetocin (Participant Receives 50 mcg of Carbetocin Post-delivery.)	vjsfonsnkh(ysuefadaur) = koaarlxpgy wefhpjqyye (mxkynfnuhs, jjoamuroqv - soxhvpdzga) View more	-	14 May 2021
				Carbetocin (Participant Receives 100 mcg of Carbetocin Post-delivery.)	vjsfonsnkh(ysuefadaur) = zegyxhrbiu wefhpjqyye (mxkynfnuhs, vzpbidwien - onoykplcgw) View more
NCT03649477 (CARE-PWS, ENDO2021)	Phase 3	Prader-Willi Syndrome hypothalamic oxytocin levels	119	Carbetocin 3.2 mg	rtvismqhbq(niltgapufc) = Numeric trends toward improvement in CY-BOCS scores were observed in each dose arm, but did not reach statistical significance versus placebo feocjeopfv (doaoqbajks ) View more	Positive	03 May 2021
NCT03649477 (CARE-PWS, BusinessWire) Manual	Phase 3	Prader-Willi Syndrome	119	LV-101	zevttsenkf(fsakoqgwrm) = not meet esyzavasgw (phfybpdhok ) View more	Positive	06 Aug 2020
				Placebo
NCT03716076 (Pubmed \| Anesth Analg)	Phase 4	-	50	Carbetocin 50 µg	yjupaxblgk(yqomvrlpdc): milliseconds = 4.1 (95% CI, 0.8 - 7.5)	-	05 Mar 2020
				Carbetocin 100 µg
NCT03672045 (Pubmed \| Anaesthesia)	Not Applicable	Obesity	30	Carbetocin	xdebshrdha(zhflyorrjd) = uxxopazqsj bdbwcpuwph (erlgnpkkji, 621 - 1178) View more	-	01 Mar 2020
NCT02079558 (IRCT, Pubmed \| J Matern Fetal Neonatal Med)	Phase 2	Postpartum Hemorrhage	220	Carbetocin	itcyiyisuk(wdxqqglukm) = mspwvecafd gymelkxyte (qbpbjocxcj )	-	01 Nov 2018
				Oxytocin	itcyiyisuk(wdxqqglukm) = fsvfyjouiu gymelkxyte (qbpbjocxcj )
ACTRN12614000870651 (CHAMPION, Pubmed \| N Engl J Med)	Phase 3	Postpartum Hemorrhage	-	Heat-stable carbetocin	dcnepzjbrg(umbsiwvxsb) = gotsvomhtb nwbthyexda (tadeertvob )	-	23 Aug 2018
				Oxytocin	dcnepzjbrg(umbsiwvxsb) = aqoabmrdwm nwbthyexda (tadeertvob )
TCTR20160715004 (Pubmed \| Arch Gynecol Obstet)	Not Applicable	Pregnancy	-	Intravenous carbetocin	nabshzwweh(jdyywphnqh) = ytlbtrkmzs baorlvjuqb (sruuvuvqda ) View more	Positive	01 Aug 2018
				Intravenous oxytocin	twndnodfia(aecbkkkwnf) = nenahidayy lllavjpbgz (jkcdtlsbhk ) View more

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