Oza Vrinda, Rawal Kalrav, Parmar Vandana, Piparva Kiran, Chakma Ashish
Anaesthesiology, Pandit Dindayal Upadhyay (PDU) Government Medical College, Rajkot, IND.
Pharamacology, All India Institute of Medical Sciences, Rajkot, IND.
Cureus. 2025 Aug 13;17(8):e89968. doi: 10.7759/cureus.89968. eCollection 2025 Aug.
Background Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality, particularly in low-resource settings. Cesarean delivery increases the risk of PPH, with uterine atony being the most common cause. Oxytocin is widely used for prevention, but has limitations due to its short half-life and storage concerns. Carbetocin, a long-acting oxytocin analogue, may offer a more stable alternative. Objective This study's objective was to compare the effectiveness, safety, and hemodynamic profile of prophylactic carbetocin vs. oxytocin for PPH prevention in high-risk cesarean deliveries. Methods The randomized, double-blind, controlled trial enrolled 70 high-risk term pregnant women undergoing elective cesarean section under spinal anesthesia. Participants were randomized to receive either carbetocin 100 µg IV bolus (group E) or oxytocin 10 IU infusion (group C - control). Uterine tone, intraoperative blood loss, additional uterotonic requirement, hemodynamic parameters, and adverse effects were assessed. An independent t-test was used for comparing quantitative variables, and the chi-square test was used for qualitative variables between the groups. Results The carbetocin group had significantly adequate uterine tone (Likert scores 4 vs. 3), lower need for additional uterotonics (2.86% vs. 28.57%, p = 0.0086), and reduced intraoperative blood loss (<500 mL in 82.86% vs. 42.86%, p = 0.001). The adequacy of uterine tone was highly significant (p < 0.0001) after three minutes of uterotonic administration in the carbetocin group. The carbetocin group had significantly higher mean arterial pressure (MAP) (e.g., 85.31% vs. 80% at five minutes; 89.89% vs. 82.14% at uterine repair; 91.09% vs. 86.09% at two hours) and lower heart rate (HR) (92.31% vs. 104.69% at five minutes; 90.8% vs. 101.14% at uterine repair) compared to the oxytocin group. Conclusion Carbetocin is a safer alternative to oxytocin for prophylactic administration to prevent PPH in high-risk cesarean deliveries with a favorable hemodynamic and safety profile.
产后出血（PPH）是孕产妇发病和死亡的主要原因，尤其是在资源匮乏地区。剖宫产会增加产后出血的风险，其中子宫收缩乏力是最常见的原因。缩宫素被广泛用于预防产后出血，但由于其半衰期短和储存问题存在局限性。卡贝缩宫素，一种长效缩宫素类似物，可能提供更稳定的替代方案。目的：本研究的目的是比较预防性使用卡贝缩宫素与缩宫素在高危剖宫产中预防产后出血的有效性、安全性和血流动力学特征。方法：这项随机、双盲、对照试验纳入了70名在脊髓麻醉下接受择期剖宫产的高危足月孕妇。参与者被随机分为接受静脉推注100μg卡贝缩宫素组（E组）或静脉输注10IU缩宫素组（C组 - 对照组）。评估子宫张力、术中失血量、额外宫缩剂需求、血流动力学参数和不良反应。使用独立t检验比较定量变量，使用卡方检验比较组间定性变量。结果：卡贝缩宫素组子宫张力明显足够（李克特评分4分对3分），额外宫缩剂需求更低（2.86%对28.57%，p = 0.0086），术中失血量减少（82.86%的患者失血量<500mL对42.86%，p = 0.001）。在卡贝缩宫素组给予宫缩剂三分钟后，子宫张力的充足程度非常显著（p < 0.0001）。与缩宫素组相比，卡贝缩宫素组平均动脉压（MAP）显著更高（例如，五分钟时85.31%对80%；子宫修复时89.89%对82.14%；两小时时91.09%对86.09%），心率（HR）更低（五分钟时92.31%对104.69%；子宫修复时90.8%对101.14%）。结论：在高危剖宫产中预防性使用卡贝缩宫素预防产后出血是缩宫素更安全的替代方案，具有良好的血流动力学和安全性特征。
