Replacing Routine Oxytocin Infusion With Single-Dose Carbetocin at Elective Caesarean Section: A Service Improvement Evaluation of Postpartum Haemorrhage Outcomes.
Replacing routine oxytocin infusion with single-dose carbetocin in elective caesarean sections showed comparable rates of significant and major postpartum haemorrhage.
Where it sits
this study against the rest of the carbetocin corpusSummary and findings
This study evaluated the replacement of routine oxytocin infusion with single-dose carbetocin in elective caesarean sections. The primary outcome measured was significant postpartum haemorrhage, defined as estimated blood loss greater than 1.5 L. The study included 838 elective caesarean sections across two cohorts, with findings indicating comparable rates of significant and major postpartum haemorrhage between the two groups.
Abstract
Background Routine postoperative oxytocin infusion after elective caesarean section can require prolonged intravenous administration, continued monitoring, and additional recovery-area resources. Single-dose carbetocin offers a simplified prophylactic uterotonic regimen, but local evaluation is important when implementing a change in practice. Methods This was a single-centre service improvement evaluation using anonymised aggregate data from women undergoing elective lower-segment caesarean section across two consecutive time periods. The oxytocin cohort included 392 elective caesarean sections performed between 1 August 2022 and 30 September 2023, during which routine prophylaxis consisted of oxytocin according to local practice, typically including postoperative infusion. The carbetocin cohort included 446 elective caesarean sections performed between 1 October 2023 and 31 December 2024, following implementation of single-dose intravenous carbetocin as routine prophylaxis. The primary clinical outcome was significant postpartum haemorrhage, defined as estimated blood loss greater than 1.5 L. The secondary clinical outcome was major postpartum haemorrhage, defined as estimated blood loss greater than 2 L. The service outcome was avoidance of routine postoperative uterotonic infusion. Results A total of 838 elective caesarean sections were included. Significant postpartum haemorrhage occurred in 10 of 392 cases in the oxytocin cohort and 12 of 446 cases in the carbetocin cohort, corresponding to rates of 2.55% and 2.69%, respectively. Major postpartum haemorrhage occurred in 2 of 392 cases in the oxytocin cohort and 4 of 446 cases in the carbetocin cohort, corresponding to rates of 0.51% and 0.90%, respectively. Following implementation of carbetocin, routine postoperative uterotonic infusion was no longer required as part of standard prophylaxis. Conclusion In this service improvement evaluation, replacing routine oxytocin infusion with single-dose carbetocin at elective caesarean section was associated with comparable rates of significant and major postpartum haemorrhage while simplifying postoperative uterotonic administration. The findings support the local safety of this practice change, although interpretation is limited by the retrospective aggregate design and absence of patient-level risk adjustment or additional morbidity outcomes.
Background
This paper addresses the clinical question of whether single-dose carbetocin can effectively replace routine oxytocin infusion in elective caesarean sections. Previous studies have shown that oxytocin infusion can require prolonged administration and monitoring, which can strain resources. The evaluation of carbetocin as a simpler alternative is important for improving postoperative care.
Methods
This was a single-centre service improvement evaluation using anonymised aggregate data from women undergoing elective lower-segment caesarean sections across two consecutive time periods. The oxytocin cohort included 392 elective caesarean sections performed between 1 August 2022 and 30 September 2023, while the carbetocin cohort included 446 elective caesarean sections performed between 1 October 2023 and 31 December 2024. The primary outcome was significant postpartum haemorrhage, defined as estimated blood loss greater than 1.5 L.
Results
The primary endpoint showed that significant postpartum haemorrhage occurred in 10 of 392 cases (2.55%) in the oxytocin cohort and 12 of 446 cases (2.69%) in the carbetocin cohort. Major postpartum haemorrhage occurred in 2 of 392 cases (0.51%) for oxytocin and 4 of 446 cases (0.90%) for carbetocin. No statistical significance was reported in the abstract.
Interpretation
The findings suggest that replacing routine oxytocin infusion with single-dose carbetocin does not significantly alter the rates of postpartum haemorrhage. However, the effect sizes are small and may not be clinically meaningful. The study's limitations, including its retrospective design and lack of patient-level risk adjustment, hinder the ability to draw definitive conclusions about the safety and efficacy of this practice change.
Key findings
- Significant postpartum haemorrhage occurred in 10 of 392 cases in the oxytocin cohort, corresponding to a rate of 2.55%.
- Significant postpartum haemorrhage occurred in 12 of 446 cases in the carbetocin cohort, corresponding to a rate of 2.69%.
- Major postpartum haemorrhage occurred in 2 of 392 cases in the oxytocin cohort, corresponding to a rate of 0.51%.
- Major postpartum haemorrhage occurred in 4 of 446 cases in the carbetocin cohort, corresponding to a rate of 0.90%.
- Following implementation of carbetocin, routine postoperative uterotonic infusion was no longer required.
Limitations
- Retrospective design limits risk adjustment.
- Absence of additional morbidity outcomes.
- Single-centre study may limit generalizability.