Goel Vanshika, Karya Urmila, Rani Anupam, Dayal Manvi
Obstetrics and Gynaecology, Lala Lajpat Rai Memorial Medical College, Meerut, IND.
Cureus. 2025 May 5;17(5):e83504. doi: 10.7759/cureus.83504. eCollection 2025 May.
Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide, particularly in developing countries. Effective uterotonic agents are crucial for minimizing blood loss and maintaining hemodynamic stability during deliveries. Carbetocin has emerged as a promising alternative to oxytocin for preventing PPH, especially in high-risk pregnancies.
This study aimed to compare the efficacy of carbetocin and oxytocin in controlling intraoperative blood loss, maintaining uterine tone, and reducing the need for additional uterotonics in women undergoing cesarean section (CS) with a high risk of PPH.
This prospective case-control study was conducted on 200 pregnant women at high risk for PPH undergoing CS after obtaining written informed consent. Participants were randomly assigned to two groups. Group I (n = 100) received injection carbetocin (100 µg IV), while Group II (n = 100) received injection oxytocin (10 IU IV in 500 mL normal saline). The hemodynamic parameters of the participants, uterine tone, blood loss, and the need for additional uterotonics were recorded and analyzed.
Carbetocin significantly reduced intraoperative blood loss, with 81 participants (81%) in the carbetocin group experiencing blood loss less than 500 mL compared to 54 participants (54%) in the oxytocin group. The need for additional uterotonics was significantly lower in the carbetocin group (13% vs. 43%; n = 100). Uterine tone was better in the carbetocin group both intraoperatively and two hours postoperatively (p < 0.0004), and the postoperative fall in hemoglobin was also less compared to the oxytocin group. Hemodynamic stability was maintained better in the carbetocin group, with fewer fluctuations in blood pressure.
Carbetocin was found to be more effective than oxytocin in managing high-risk cesarean deliveries, offering better control over intraoperative blood loss, maintaining uterine tone, and reducing the need for additional uterotonics. Its prolonged uterotonic effect and stable hemodynamic profile make it a superior choice for PPH prevention in CSs.
产后出血（PPH）是全球孕产妇发病和死亡的主要原因，在发展中国家尤为如此。有效的宫缩剂对于在分娩期间减少失血和维持血流动力学稳定至关重要。卡贝缩宫素已成为预防PPH的一种有前景的催产素替代药物，尤其是在高危妊娠中。
本研究旨在比较卡贝缩宫素和催产素在控制剖宫产（CS）术中失血、维持子宫张力以及减少PPH高危剖宫产妇女额外使用宫缩剂需求方面的疗效。
本前瞻性病例对照研究在200名PPH高危孕妇签署书面知情同意书后进行剖宫产时开展。参与者被随机分为两组。第一组（n = 100）接受卡贝缩宫素注射液（100μg静脉注射），而第二组（n = 100）接受催产素注射液（500mL生理盐水中含10IU静脉注射）。记录并分析参与者的血流动力学参数、子宫张力、失血量以及额外使用宫缩剂的需求。
卡贝缩宫素显著减少了术中失血，卡贝缩宫素组81名参与者（81%）失血量少于500mL，而催产素组为54名参与者（54%）。卡贝缩宫素组额外使用宫缩剂的需求显著更低（13%对43%；n = 100）。卡贝缩宫素组术中及术后两小时子宫张力均更好（p < 0.0004），与催产素组相比，术后血红蛋白下降也更少。卡贝缩宫素组血流动力学稳定性维持得更好，血压波动更少。
发现卡贝缩宫素在处理高危剖宫产时比催产素更有效，在控制术中失血、维持子宫张力以及减少额外使用宫缩剂需求方面表现更佳。其延长的宫缩作用和稳定的血流动力学特征使其成为剖宫产中预防PPH的更佳选择。
