Carbetocin versus oxytocin during elective cesarean delivery: A randomized double-blind trial.
Carbetocin may reduce intraoperative blood loss and the need for additional uterotonics compared to oxytocin during elective cesarean delivery.
Where it sits
this study against the rest of the carbetocin corpusSummary and findings
This study compared carbetocin and oxytocin in 100 patients undergoing elective cesarean delivery, focusing on intraoperative blood loss and uterine tone. Carbetocin was administered as a 100 μg intravenous bolus, while oxytocin was given as a 0.6 IU bolus followed by a 15 IU/h infusion. The results indicated that carbetocin was associated with lower blood loss and reduced need for additional uterotonics.
Abstract
Objective Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity following cesarean delivery. This study aimed to compare the effects of carbetocin and oxytocin on intraoperative blood loss during elective cesarean delivery, with secondary evaluation of uterine tone, additional uterotonic requirements, and intraoperative hemodynamic parameters. Methodology This prospective, randomized, double-blind study was conducted at Van Yuzuncu Yil University Dursun Odabaş Medical Center between 2023 and 2024 and included 100 patients undergoing elective cesarean delivery. Patients were randomly assigned to receive either oxytocin (Group O; 0.6 IU intravenous bolus followed by a 15 IU/h infusion) or carbetocin (Group C; 100 μg administered intravenously over 30-60 seconds). Patients with major obstetric complications, placental invasion disorders, hypertensive disorders of pregnancy, significant cardiovascular or respiratory disease, or hepatic or renal dysfunction were excluded. Intraoperative blood loss, uterine tone, additional uterotonic requirements, and hemodynamic parameters were compared. Results Baseline demographic characteristics were comparable between groups (p>0.05). Intraoperative blood loss was significantly lower in the carbetocin group than in the oxytocin group (p<0.001). The need for additional uterotonic agents was significantly lower in the carbetocin group both within the first 5 minutes (2% vs. 12%) and throughout surgery (10% vs. 26%) (p<0.05 for both). Uterine tone was significantly higher in the carbetocin group at 5 minutes (p=0.016), whereas higher scores were observed in the oxytocin group at 10 minutes (p=0.034). No clinically significant differences were observed in intraoperative hemodynamic parameters. Conclusion Although carbetocin and oxytocin demonstrated comparable intraoperative hemodynamic profiles, carbetocin was associated with reduced intraoperative blood loss, improved early uterine tone, and a lower requirement for additional uterotonic agents. Its single-dose administration and favorable safety profile make it a practical and effective uterotonic option for elective cesarean delivery.
Background
This paper addresses the clinical question of how carbetocin compares to oxytocin in managing intraoperative blood loss during elective cesarean delivery. Previous studies have indicated that postpartum hemorrhage is a leading cause of maternal morbidity, highlighting the need for effective uterotonics. Understanding the comparative effectiveness of these two agents is critical for improving maternal outcomes during cesarean deliveries.
Methods
This was a prospective, randomized, double-blind study conducted at Van Yuzuncu Yil University Dursun Odabaş Medical Center with 100 patients undergoing elective cesarean delivery. Participants were randomly assigned to receive either oxytocin (0.6 IU intravenous bolus followed by a 15 IU/h infusion) or carbetocin (100 μg intravenously over 30-60 seconds). The primary outcome was intraoperative blood loss, with secondary outcomes including uterine tone, additional uterotonic requirements, and hemodynamic parameters.
Results
The primary endpoint showed that intraoperative blood loss was significantly lower in the carbetocin group than in the oxytocin group (p<0.001). The need for additional uterotonics was lower in the carbetocin group at both 5 minutes (2% vs. 12%, p<0.05) and throughout surgery (10% vs. 26%, p<0.05). Uterine tone was significantly higher in the carbetocin group at 5 minutes (p=0.016), while the oxytocin group had higher scores at 10 minutes (p=0.034). No clinically significant differences were noted in hemodynamic parameters.
Interpretation
The findings suggest that carbetocin may be more effective than oxytocin in reducing intraoperative blood loss and the need for additional uterotonics during elective cesarean deliveries. However, while the statistical significance is clear, the clinical significance of these findings should be carefully considered, especially given the study's limitations such as a single-site design and exclusion criteria. These results may inform practice but should be interpreted with caution.
Key findings
- Intraoperative blood loss was significantly lower in the carbetocin group than in the oxytocin group (p<0.001).
- The need for additional uterotonic agents was significantly lower in the carbetocin group within the first 5 minutes (2% vs. 12%, p<0.05).
- The need for additional uterotonic agents was significantly lower in the carbetocin group throughout surgery (10% vs. 26%, p<0.05).
- Uterine tone was significantly higher in the carbetocin group at 5 minutes (p=0.016).
- Higher uterine tone scores were observed in the oxytocin group at 10 minutes (p=0.034).
- No clinically significant differences were observed in intraoperative hemodynamic parameters.
Limitations
- Single-site study may limit generalizability.
- Exclusion of patients with major obstetric complications.
- Short follow-up period.
- No long-term outcomes reported.