Comparative Efficacy of Intramuscular Oxytocin and Carboprost Tromethamine in Postpartum Hemorrhage Prophylaxis: A Randomized Controlled Trial

Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality worldwide, despite the preventive benefits of active management in the third stage of labor. Oxytocin is widely used for PPH prevention; however, its effectiveness is sometimes limited, necessitating alternative or additional uterotonics. Carboprost tromethamine, a prostaglandin analogue, offers potential advantages, but comparative studies are limited. This study aimed to compare the efficacy of intramuscular oxytocin (10 units) versus intramuscular carboprost tromethamine (125 µg) in reducing blood loss during the third stage of labor and in minimizing the need for additional uterotonics. Methods: In a randomized controlled trial, 266 women undergoing vaginal delivery were assigned to receive either oxytocin (Group A) or carboprost tromethamine (Group B) as PPH prophylaxis. Primary outcomes included the duration of the third stage of labor and estimated blood loss, with secondary outcomes of additional uterotonic requirement, hemoglobin change, and side effects. Results: Mean third-stage duration was significantly shorter in the carboprost group (6.18 min) than the oxytocin group (6.71 min, p < 0.05). Mean blood loss was also significantly lower with carboprost (183.44 ml) compared to oxytocin (285.77 ml, p < 0.001). Additional uterotonics were needed less frequently in the carboprost group (3%) versus the oxytocin group (15.8%, p < 0.05). Diarrhea was more common in the carboprost group. Conclusion: Carboprost tromethamine demonstrated superior efficacy in reducing blood loss and third-stage duration compared to oxytocin, with a manageable side effect profile. These findings support carboprost as an effective alternative for PPH prophylaxis.