Carbetocin vs oxytocin for prevention of postpartum hemorrhage in women with obesity undergoing cesarean delivery: A systematic review and meta-analysis.
Carbetocin may reduce postpartum hemorrhage more effectively than oxytocin in obese women undergoing cesarean delivery, but larger studies are needed to confirm these findings.
Where it sits
this study against the rest of the carbetocin corpusSummary and findings
This systematic review and meta-analysis compared carbetocin to oxytocin for preventing postpartum hemorrhage in obese women undergoing cesarean delivery. Three RCTs with 269 participants were analyzed, showing carbetocin reduced blood loss and the need for blood transfusions more than oxytocin. The findings suggest potential benefits of carbetocin, but larger trials are needed for confirmation.
Abstract
<h4>Objective</h4>To compare the effectiveness and safety of carbetocin versus oxytocin for the prevention of postpartum hemorrhage in women with obesity undergoing cesarean delivery.<h4>Study design</h4>PubMed, CENTRAL, and Embase databases were searched from inception through July 2025, with no language restrictions. Randomized controlled trials were included. Outcomes assessed were mean blood loss, need for blood transfusion, use of additional uterotonics, hemodynamic parameters, and adverse events. Random-effects meta-analyses were performed in R software. Continuous outcomes were pooled as mean differences (MD), and binary outcomes as risk ratios (RR). Statistical heterogeneity was assessed using the I² statistic.<h4>Results</h4>Three RCTs (n = 269 participants) were included. Carbetocin was associated with a greater reduction in blood loss than oxytocin (MD -230.11 ml; 95% CI -370.90 to -89.33; p = 0.0014), and significantly fewer blood transfusions when compared to oxytocin (RR 0.14; 95% CI 0.03 to 0.63; p = 0.011); although these results lacked robustness in sensitivity analysis. However, in the pooled and sensitivity analyses, carbetocin demonstrated a significant and consistent reduction in the incidence of postpartum hemorrhage (RR 0.19; 95% CI 0.06 to 0.63; p = 0.006).<h4>Conclusions</h4>Carbetocin was associated with significantly reduced incidence of postpartum hemorrhage compared with oxytocin in obese women undergoing cesarean delivery. These findings suggest potential benefit of carbetocin in this high-risk population; however, larger, high-quality trials are required to confirm these results.
Background
Postpartum hemorrhage is a significant concern in obstetric care, particularly in women with obesity undergoing cesarean delivery, due to increased risk factors. Oxytocin is commonly used for prevention, but carbetocin, a longer-acting oxytocin analogue, may offer advantages. This study aims to evaluate whether carbetocin is more effective and safer than oxytocin in this specific population.
Methods
This systematic review and meta-analysis included randomized controlled trials comparing carbetocin to oxytocin for preventing postpartum hemorrhage in obese women undergoing cesarean delivery. Databases searched included PubMed, CENTRAL, and Embase up to July 2025. Outcomes measured were mean blood loss, need for blood transfusion, use of additional uterotonics, hemodynamic parameters, and adverse events. Random-effects meta-analyses were conducted using R software, with continuous outcomes pooled as mean differences and binary outcomes as risk ratios.
Results
The analysis included three RCTs with a total of 269 participants. Carbetocin significantly reduced blood loss compared to oxytocin, with a mean difference of -230.11 ml (95% CI -370.90 to -89.33; p = 0.0014). It also resulted in significantly fewer blood transfusions (RR 0.14; 95% CI 0.03 to 0.63; p = 0.011). The incidence of postpartum hemorrhage was consistently reduced with carbetocin (RR 0.19; 95% CI 0.06 to 0.63; p = 0.006), although sensitivity analyses indicated some lack of robustness.
Interpretation
The findings suggest that carbetocin may be more effective than oxytocin in reducing postpartum hemorrhage and related interventions in obese women undergoing cesarean delivery. However, the clinical significance is tempered by the small sample size and lack of robustness in sensitivity analyses. These results align with previous studies suggesting benefits of carbetocin but highlight the need for larger, high-quality trials to confirm these findings.
Key findings
- MD -230.11 ml blood loss with carbetocin vs oxytocin; 95% CI -370.90 to -89.33; p = 0.0014
- RR 0.14 for blood transfusions with carbetocin vs oxytocin; 95% CI 0.03 to 0.63; p = 0.011
- RR 0.19 for postpartum hemorrhage incidence with carbetocin; 95% CI 0.06 to 0.63; p = 0.006
- Three RCTs included, n = 269 participants
- Statistical heterogeneity assessed with I²
Limitations
- Small n=269 across three RCTs
- Results lacked robustness in sensitivity analysis
- Potential publication bias due to limited number of studies
- Short follow-up period in included trials