Oxytocin versus Carbetocin: Preventing Postpartum Hemorrhage in Elective C-section.
Carbetocin may be associated with improved uterine tone and reduced need for additional medications compared to oxytocin in preventing postpartum hemorrhage during elective cesarean delivery.
Where it sits
this study against the rest of the carbetocin corpusSummary and findings
This study compared the efficacy and safety of intramuscular carbetocin versus intravenous oxytocin in preventing postpartum hemorrhage during elective cesarean delivery. Sixty pregnant women were divided into two groups, receiving either 100 μg carbetocin or 20 IU oxytocin. The study reported significant differences in hemodynamic stability and uterine tone between the two groups.
Abstract
<h4>Background</h4>Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, particularly following cesarean delivery (CD). Uterotonics are routinely administered to prevent uterine atony and reduce PPH risk. This study aimed to compare the efficacy and safety of intramuscular carbetocin versus intravenous oxytocin in preventing PPH during elective CD under spinal anesthesia.<h4>Methods</h4>This comparative observational study was conducted at a tertiary care hospital in India. Sixty pregnant women undergoing elective CD under spinal anesthesia were divided into two groups: Group C received intramuscular carbetocin 100 μg, and Group O received intravenous oxytocin infusion 20 IU. Primary outcome was changes in hemodynamic parameters, including heart rate, blood pressure (BP), and mean arterial pressure (MAP); secondary outcomes included uterine tone scores, need for additional uterotonics, and requirement for vasoactive agents.<h4>Results</h4>Hemodynamic parameters, including MAP and diastolic BP remained more stable in the carbetocin group. Carbetocin demonstrated better uterine tone at 2, 5, and 10 min postdelivery (P < 0.001). The need for additional uterotonics was significantly lower in the carbetocin group (10% vs. 40%, P = 0.007), and only 3.3% required vasoactive agents compared to 53.3% in the oxytocin group (P < 0.001).<h4>Conclusion</h4>Carbetocin was associated with improved uterine tone, reduced need for additional uterotonics, and better cardiovascular stability compared to oxytocin. These findings suggest that intramuscular carbetocin may be a more effective and safer alternative to intravenous oxytocin for PPH prevention in elective CD.
Background
Postpartum hemorrhage (PPH) is a significant cause of maternal morbidity and mortality, especially after cesarean deliveries. Uterotonics are commonly used to prevent uterine atony, which can lead to PPH. Previous studies have shown varying efficacy between different uterotonics, making it important to compare alternatives like carbetocin and oxytocin in this context.
Methods
This was a comparative observational study conducted at a tertiary care hospital in India involving 60 pregnant women undergoing elective cesarean delivery under spinal anesthesia. Participants were divided into two groups: one receiving intramuscular carbetocin 100 μg and the other receiving intravenous oxytocin 20 IU. The primary outcomes measured were hemodynamic parameters, while secondary outcomes included uterine tone scores and the need for additional uterotonics.
Results
The primary outcome showed that hemodynamic parameters, including mean arterial pressure (MAP) and diastolic blood pressure (BP), remained more stable in the carbetocin group. The need for additional uterotonics was significantly lower in the carbetocin group at 10% compared to 40% in the oxytocin group (P = 0.007). Additionally, only 3.3% of the carbetocin group required vasoactive agents compared to 53.3% in the oxytocin group (P < 0.001).
Interpretation
The findings suggest that carbetocin may offer better hemodynamic stability and uterine tone compared to oxytocin, aligning with previous literature that indicates potential advantages of carbetocin. However, the clinical significance of these findings should be considered in light of the small sample size and observational nature of the study, which may introduce confounding factors.
Key findings
- Carbetocin group had a need for additional uterotonics of 10% vs. 40% in the oxytocin group, P = 0.007.
- Only 3.3% of the carbetocin group required vasoactive agents compared to 53.3% in the oxytocin group, P < 0.001.
- Carbetocin demonstrated better uterine tone at 2, 5, and 10 min postdelivery, P < 0.001.
Limitations
- small sample size of 60 participants
- observational study design
- single-site study may limit generalizability
- no long-term follow-up reported