Systematic use of carbetocin during cesarean delivery of multiple pregnancies: a before-and-after study

Cesarean deliveries of multiple pregnancies are associated with a high risk of hemorrhage. The aim of this study is to evaluate the efficacy of carbetocin administered systematically during cesarean deliveries of multiple pregnancies.

Single-center retrospective before-and-after study comparing the use of carbetocin to that of oxytocin during cesareans during two consecutive 6-month periods. A composite variable was predefined as the principal endpoint: any one or more of bleeding ≥1,500 mL, transfusion, hemoglobin reduction of 4 g/dL or more or operative intervention (surgery, embolization).

In an intention-to-treat analysis, the comparison of the two groups (n = 24 before and n = 39 after) showed no difference for the occurrence of the composite variable (16.7 vs. 15.4 %, p = 0.89). Nor did the per-protocol analysis (n = 24 before and n = 27 after) differ for it (16.7 vs. 14.8 %, p = 0.86). Moreover, none of the secondary outcome measures studied-moderate blood loss, prescription of sulprostone, cell-saver use, and intravenous iron infusion-differed significantly between the two periods.

In our population of multiple pregnancies delivered by cesarean, carbetocin did not appear more effective than oxytocin in preventing severe postpartum hemorrhage.