Comparative efficacy of carbetocin versus oxytocin in preventing postpartum hemorrhage during lower segment cesarean section: a prospective randomized controlled trial

Background: This study was conducted to compare the efficacy of a single-dose carbetocin with oxytocin infusion in preventing postpartum hemorrhage (PPH) during lower segment cesarean section (LSCS).

Methods: A prospective randomized controlled trial was conducted on 120 pregnant women undergoing elective or emergency LSCS at a tertiary care hospital in the state of Maharashtra. The study participants were randomly assigned to receive either a single intravenous dose of 100 μg carbetocin (n=60) or 20 IU oxytocin infusion (n=60) after delivery of the baby. The primary outcome assessed was the incidence of PPH (blood loss ≥1000 ml) whereas the secondary outcomes included mean blood loss, need for additional uterotonics and blood transfusion requirements.

Results: The incidence of PPH was significantly lower in the carbetocin group (3.3%) compared to the oxytocin group (15.0%) (p=0.026). The mean blood loss was 435.2±152.8 ml in the carbetocin group versus 624.7±218.4 ml in the oxytocin group (p<0.001). Additional uterotonics were required in 5% of patients in the carbetocin group versus 18.3% in the oxytocin group (p=0.021). Blood transfusion was needed in 1.7% of women in the carbetocin group compared to 8.3% in the oxytocin group (p=0.048).

Conclusions: A single-dose carbetocin is more effective than oxytocin infusion in preventing PPH during LSCS, with reduced requirement for additional uterotonics and blood transfusions.