Carbetocin versus Oxytocin with or without Tranexamic Acid for Prophylactic Prevention of Postpartum Hemorrhage after a Vaginal Delivery: A Randomized Clinical Trial

Abstract

<b><i>Objective:</i></b> Our study’s primary objective was to examine the effects of four different prophylactic protocols on the prevention of postpartum hemorrhage following vaginal birth, including carbetocin only, oxytocin only, and a combination of carbetocin or oxytocin with tranexamic acid. <b><i>Design:</i></b> A multicentric randomized controlled trial. <b><i>Participants/Materials, Setting, and Methods:</i></b> This multicentric center prospective randomized controlled trial was conducted at the Department of Obstetrics and Gynecology of Bezmialem University and Van Health Teaching and Research Hospital from August 2022 to January 2023. The collected data included age, gravidity, parity, gestational age at birth, duration of delivery stages, prepartum hemoglobin and hematocrit concentrations, changes in hemoglobin and hematocrit concentrations, intrapartum blood loss, estimated blood loss after 2 h of vaginal delivery, Apgar scores at 1 and 5 min, birth weight, and neonatal intensive care unit (NICU) admission. Intrapartum blood loss was objectively measured in milliliters using a postpartum drape with a calibrated bag. The amount of bleeding was measured by subtracting the empty weight of the pads placed under the patient in the patient’s bed within 2 h after delivery. Group I: carbetocin 100 μg/mL (<i>n</i> = 75), group II: oxytocin 5 IU/mL (<i>n</i> = 75), group III: carbetocin and tranexamic acid 50 mg/mL (<i>n</i> = 75), group IV: oxytocin and tranexamic acid (<i>n</i> = 75). <b><i>Results:</i></b> The hemoglobin concentration decrease significantly differed between groups (1.03 ± 1.04, 1.3 ± 0.85, 1.4 ± 0.85, 1.41 ± 0.87, respectively; <i>p</i> < 0.001). Group 4 has the highest decrease in hemoglobin and hematocrit concentrations. When we investigated the subgroup differences, the decrease in hemoglobin concentration was significantly higher in group 2 than group 1 (1.30 ± 0.85 vs. 1.03 ± 1.04; <i>p</i> = 0.023), in group 2 than group 3 (1.3 ± 0.85 vs. 1.04 ± 0.9; <i>p</i> = 0.013), and in group 4 than group 3 (1.41 ± 0.87 vs. 1.04 ± 0.9; <i>p</i> < 0.001). The decrease in hematocrit level was significantly different between groups (3.07 ± 3.23, 3.55 ± 2.44, 2.13 ± 3.09, 4.25 ± 2.52; <i>p</i> < 0.001, respectively). No significant differences were observed in terms of mean blood loss between the four groups (277.19 ± 208.10, 294.13 ± 198.64, 274.33 ± 199.57, and 283.97 ± 178.11; <i>p</i> = 0.445, respectively). Furthermore, there was no significant difference between the groups in the rate of need for blood transfusion (1.3%, 5.4%, 4%, and 4%, respectively; <i>p</i> = 0.6). <b><i>Limitations:</i></b> The most important limitation of the study is a relatively small number of participants. <b><i>Conclusion:</i></b> In conclusion, our findings suggest that carbetocin may be more successful than oxytocin and oxytocin plus tranexamic acid regimens in terms of postpartum hemoglobin reduction, and there is no difference in terms of the need for blood transfusion when it is used for postpartum hemorrhage prophylaxis after vaginal delivery.