Oxytocin versus Carbetocin: Preventing Postpartum Hemorrhage in Elective C-section

Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, particularly following cesarean delivery (CD). Uterotonics are routinely administered to prevent uterine atony and reduce PPH risk. This study aimed to compare the efficacy and safety of intramuscular carbetocin versus intravenous oxytocin in preventing PPH during elective CD under spinal anesthesia.

This comparative observational study was conducted at a tertiary care hospital in India. Sixty pregnant women undergoing elective CD under spinal anesthesia were divided into two groups: Group C received intramuscular carbetocin 100 μg, and Group O received intravenous oxytocin infusion 20 IU. Primary outcome was changes in hemodynamic parameters, including heart rate, blood pressure (BP), and mean arterial pressure (MAP); secondary outcomes included uterine tone scores, need for additional uterotonics, and requirement for vasoactive agents.

Hemodynamic parameters, including MAP and diastolic BP remained more stable in the carbetocin group. Carbetocin demonstrated better uterine tone at 2, 5, and 10 min postdelivery (P < 0.001). The need for additional uterotonics was significantly lower in the carbetocin group (10% vs. 40%, P = 0.007), and only 3.3% required vasoactive agents compared to 53.3% in the oxytocin group (P < 0.001).

Carbetocin was associated with improved uterine tone, reduced need for additional uterotonics, and better cardiovascular stability compared to oxytocin. These findings suggest that intramuscular carbetocin may be a more effective and safer alternative to intravenous oxytocin for PPH prevention in elective CD.