Effectiveness of prophylactic carbetocin versus oxytocin following vaginal delivery for preventing severe postpartum hemorrhage

Abstract

ObjectiveTo compare the effectiveness of prophylactic carbetocin with prophylactic oxytocin for preventing severe postpartum hemorrhage (PPH) following vaginal delivery.MethodsThis before and after cohort study took place between 2020 and 2021 in a university maternity hospital. In 2021, the protocol for PPH prevention immediately after vaginal delivery changed: intravenous oxytocin (5 IU) was replaced by intravenous carbetocin (100 μg). All patients with vaginal births were included, with two groups compared: patients who received prophylactic oxytocin in 2020 and those who received prophylactic carbetocin in 2021. The primary outcome was severe PPH, defined as one or more of the following: estimated blood loss ≥1500 mL, transfusion ≥4 units of red blood cells, Bakri balloon use, embolization, vascular ligation, hysterectomy, and maternal death.ResultsAmong 4832 women included, 2417 received oxytocin and 2415 received carbetocin. The rate of severe PPH was similar in both groups (0.5% vs. 0.6%, respectively; adjusted odds ratio, 0.8 [95% confidence interval, 0.4–1.8]). The rate of PPH ≥500 mL was lower in the carbetocin group (4% vs. 5.8%; P = 0.004).ConclusionAlthough prophylactic carbetocin was associated with a reduction in the rate of PPH ≥500 mL, carbetocin is no different to oxytocin in preventing severe PPH caused by atony after vaginal delivery.

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

“…In a randomized controlled study by Liu et al [14] in 2018 comparing two groups administered iv carbetocin versus oxytocin after vaginal delivery in high-risk women, no significant difference was found in terms of postpartum bleeding over 500 mL (29.6% vs. 26.8%, p = 0.48) and mean postpartum bleeding amount (422.9 ± 241.4 vs. 406.0 ± 257.5, p = 0.40), like our study. In the cohort study of Korb et al [11] published in 2023, which included 4,832 women who had vaginal deliveries, there was no difference between the oxytocin and carbetocin groups in terms of severe PHH, but the rate of bleeding more than 500 mL was reported to be lower in the carbetocin group (4% vs. 5%; p = 0.004). Identical to our study, there was no significant difference between the blood transfusion recipient rates (1.45% vs. 1.36%) ( p = 0.799).…”

“…Heat-stable carbetocin, a uterotonic recommended for PPH prevention and TXA, an antifibrinolytic recommended for PPH treatment, were recently added to the core list of reproductive health medicines in the 2019 Model List of Essential Medicines by the WHO [8][9][10]. Data suggest that carbetocin may be as good an option as oxytocin for PPH prevention [11]. However, randomized controlled studies on the subject are limited.…”