Carbetocin vs Oxytocin in Emergency Cesarean Delivery: Bleeding Outcomes Within 24 Hours
In antenatally low-risk women undergoing emergency cesarean delivery, carbetocin and oxytocin appear to have similar effects on bleeding outcomes within 24 hours.
Where it sits
this study against the rest of the carbetocin corpusSummary and findings
This study compared prophylactic carbetocin and oxytocin for bleeding-related outcomes within 24 hours after emergency cesarean delivery in antenatally low-risk women. A total of 300 women were included, receiving either 10 IU of oxytocin or 100 µg of carbetocin. The results indicated comparable outcomes between the two groups regarding additional uterotonic use and hemoglobin levels.
Abstract
Abstract Background Postpartum hemorrhage remains a major cause of maternal morbidity, and cesarean delivery is associated with greater blood loss than vaginal birth. This study compared prophylactic oxytocin and carbetocin for bleeding-related outcomes within 24 hours after NICE Category 1–2 emergency cesarean delivery in antenatally low-risk women and identified intrapartum factors associated with additional uterotonic use. Methods This prospective observational comparative study was conducted between October 2024 and August 2025. Antenatally low-risk women admitted for intended vaginal birth who subsequently required NICE Category 1–2 emergency cesarean delivery received oxytocin 10 IU IV or carbetocin 100 µg IV immediately after delivery. The primary outcome was any additional uterotonic use within 24 hours. Secondary outcomes were tranexamic acid use, hemoglobin decrease ≥ 2 g/dL at 24 hours, absolute hemoglobin change (ΔHb), and postoperative hemoglobin < 8 g/dL. Multivariable logistic regression was performed for the primary outcome. Results A total of 300 women were included, with 150 in each group. Additional uterotonic use occurred in 24.0% (36/150) of the carbetocin group and 33.3% (50/150) of the oxytocin group (p = 0.074). Tranexamic acid use was similar between groups (18.7% vs 16.0%, p = 0.542). Hemoglobin decrease ≥ 2 g/dL occurred in 68.0% and 60.0%, respectively (p = 0.149). Mean ΔHb was 2.49 ± 1.13 g/dL in the carbetocin group and 2.38 ± 1.03 g/dL in the oxytocin group (p = 0.388). Postoperative hemoglobin < 8 g/dL occurred in 11.3% and 12.0%, respectively (p = 0.981). In multivariable analysis, induction/augmentation (adjusted OR 1.92, 95% CI 1.07–3.42, p = 0.028) and longer duration of membrane rupture (adjusted OR 1.23 per doubling, 95% CI 1.06–1.43, p = 0.006) were independently associated with additional uterotonic use, whereas uterotonic group was not (adjusted OR for oxytocin vs carbetocin 1.51, 95% CI 0.90–2.54, p = 0.122). Conclusions In antenatally low-risk women who underwent emergency cesarean delivery, prophylactic carbetocin and oxytocin showed comparable bleeding-related outcomes within 24 hours. Additional uterotonic use was numerically lower with carbetocin, but the difference was not statistically significant. Induction/augmentation and longer duration of membrane rupture were independently associated with higher odds of additional uterotonic use. Trial registration: ClinicalTrials.gov (NCT07380529), first submitted on 18 January 2026. Retrospectively registered.