Efficacy of Carbetocin versus Conventional Uterotonic Regimens in Reducing Postpartum Blood Loss: A Comparative Study in Low-Risk Vaginal and Cesarean Deliveries

Carbetocin may reduce postpartum blood loss more effectively than traditional multi-drug regimens in vaginal deliveries, but further studies are needed to confirm these findings.

Summary and findings

This study measured the efficacy of carbetocin versus conventional uterotonic regimens in reducing postpartum blood loss in low-risk vaginal and Cesarean deliveries. Patients received either carbetocin (100 µg) or a triple-drug combination for vaginal deliveries, and carbetocin was compared with oxytocin alone for Cesarean sections. The findings indicated that carbetocin significantly reduced blood loss in vaginal deliveries and provided better hemodynamic stability in Cesarean sections.

Abstract

<title>Abstract</title> <p> Background Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide, primarily driven by uterine atony. While oxytocin remains the standard prophylaxis, carbetocin, a long-acting oxytocin analogue, has emerged as a potential alternative. This study compares the clinical efficacy of carbetocin versus conventional multi-drug uterotonic regimens in preventing blood loss during vaginal and Cesarean deliveries in a Taiwanese clinical setting. Methods We conducted a retrospective observational study of 128 patients delivered by a single obstetrician. Patients undergoing vaginal delivery received either carbetocin (100 µg) or a triple-drug combination (oxytocin, misoprostol, and methylergonovine). For Cesarean sections, carbetocin was compared with oxytocin alone. High-risk pregnancies were excluded to focus on low-risk populations. Statistical analysis was performed using the Mann-Whitney U test and Fisher’s exact test. Results In vaginal deliveries, carbetocin significantly reduced both primary and total blood loss compared to the triple-drug regimen (100 mL vs. 150 mL, <italic>P</italic>  < 0.001; 155 mL vs. 200 mL, <italic>P</italic>  = 0.047). In Cesarean sections, although visual blood loss estimation showed no significant difference, the carbetocin group demonstrated a significantly lower hemoglobin drop compared to cases managed by other physicians using conventional agents ( -6.3% vs. -11.93%, <italic>P</italic>  = 0.049). Conclusion Carbetocin as a single-agent prophylaxis is more effective than traditional multi-drug combinations in reducing blood loss during vaginal delivery. Furthermore, carbetocin provides superior hemodynamic stability in low-risk parturients and may effectively mitigate inter-operator variability. Trial registration: Retrospectively registered </p>

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