Carbetocin for the Prevention of Postpartum Hemorrhage: A Comparative Study

Postpartum hemorrhage (PPH) remains a major obstetric emergency and a leading cause of maternal morbidity and mortality. Uterotonics administered during the third stage of labor play a crucial role in its prevention. Carbetocin has emerged as a potential alternative to oxytocin due to its prolonged uterotonic effect and improved pharmacological profile. The study aimed to evaluate the effectiveness and safety of carbetocin in the prevention of PPH and to compare its outcomes with oxytocin using a combined intramuscular and intravenous oxytocin regimen in women undergoing vaginal or caesarean delivery.

This prospective observational comparative study was conducted among 100 women (50 in each group) receiving either carbetocin (100 µg intramuscularly) or oxytocin (10 IU intramuscularly with additional intravenous infusion as per institutional protocol) immediately after delivery. Estimated blood loss, incidence of PPH (defined as ≥500 mL for vaginal delivery and ≥1000 mL for cesarean section), fall in hemoglobin, hemodynamic changes, and requirement for additional uterotonics were noted. Statistical analysis was performed, and a p-value <0.05 was considered significant.

Baseline characteristics were comparable between groups. Mean estimated blood loss was significantly lower in the carbetocin group (410 ± 85 mL) compared to the oxytocin group (520 ± 110 mL; p<0.001). PPH occurred in three (6%) women in the carbetocin group versus 12 (24%) women in the oxytocin group (p=0.01). The mean fall in hemoglobin was lower with carbetocin (0.6 ± 0.4 g/dL vs 1.1 ± 0.6 g/dL; p<0.001). Additional uterotonics were required in two (4%) women receiving carbetocin compared to 11 (22%) women receiving oxytocin (p=0.007). Carbetocin was associated with better hemodynamic stability.

Carbetocin was associated with reduced blood loss, lower PPH incidence, and improved hemodynamic stability compared to oxytocin within the context of differing prophylactic regimens. However, larger randomized studies are required to confirm these findings.