Hemodynamic and Uterotonic Effects of Carbetocin Versus Oxytocin in a Cesarean Section With a High Risk of Postpartum Hemorrhage.

INTRODUCTION

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.

AIMS AND OBJECTIVES

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.

MATERIALS AND METHODS

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.

RESULTS

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.

CONCLUSION

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.