Evaluating the efficacy of carbetocin versus oxytocin for preventing intraoperative blood loss, early postpartum hemorrhage, and maintaining a favorable hemodynamic profile in lower segment cesarean section: A prospective observational study

Background: Postpartum hemorrhage (PPH) remains a significant concern in obstetric practice, contributing substantially to maternal morbidity and mortality worldwide. Uterine atony, characterized by inadequate uterine muscle tone, constitutes approximately 70% of PPH cases. The initial step in medical management involves the use of uterotonic agents such as oxytocin, ergot alkaloids, and prostaglandins. However, their use is compounded by the accompanying side effects, hence the need for uterotonic agents with relatively better pharmacokinetic and pharmacodynamic profile continues. Carbetocin may require less additional uterotonic administration to manage blood loss compared to oxytocin alone. Carbetocin has a significantly longer half-life than oxytocin, potentially leading to more sustained uterine contractions and reduced blood loss. Aims and Objectives: The aim of this study was to compare the efficacy of carbetocin versus oxytocin in preventing intraoperative blood loss and their individual impact on hemodynamics. Materials and Methods: A total of 360 patients were enrolled for the study, sample size was calculated using Cochran’s formula considering 95% confidence level, and 0.5 variability of proportions and a precision of 5%, with 180 patients in each group, using simple randomization technique, the patients in either group received their assigned drugs during lower segment cesarean section (LSCS). Both the groups were assessed in terms of hemodynamic profile, intraoperative blood loss, need for additional uterotonic agents, and blood transfusion. Results: On comparing the data between carbetocin group and oxytocin group, the carbetocin group had less incidence of hypotension and tachycardia (P<0.001), less intraoperative blood loss (Group C: Group O, mean±SD mL; 328.7±72.59:435.9±99.08 [P<0.001]), and minimal use of additional uterotonic agents (P<0.001); however, the requirement of blood transfusion was comparable between the two groups (P=0.157). Conclusions: Carbetocin is an effective alternative to conventionally used oxytocin in LSCS.