The Effectiveness of Carbetocin in the Prevention of Primary Postpartum Hemorrhage in Women Undergoing Vaginal Delivery at the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria

A bstract Background: Postpartum hemorrhage (PPH) is a major cause of maternal death worldwide, and oxytocin has been the standard therapy for its prevention. However, oxytocin requires continuous cold storage, which is not readily available in low-resource settings. Carbetocin is a heat-stable synthetic analog of oxytocin that has been recommended for the prevention of PPH. Objective: To evaluate the effectiveness of carbetocin versus oxytocin in preventing primary PPH following vaginal delivery at the Niger Delta University Teaching Hospital, (NDUTH), Okolobiri, Bayelsa State, Nigeria. Materials and Methods: This was a double-blind equivalence randomized controlled trial (RCT), conducted at the NDUTH, to evaluate the efficacy of carbetocin versus oxytocin following vaginal delivery. Participants were randomized to receive intramuscular injections of either 100 μg carbetocin or 10 IU oxytocin as prophylaxis. The primary outcome measure was postpartum estimated blood loss (within 24 h) after vaginal delivery. The secondary outcome measures were the need for additional uterotonics, change in hematocrit post-delivery, and the side effects of the drugs. Data was analyzed using IBM SPSS version 25. The test of significance was conducted using the chi-square ( χ 2 ) and the independent Student t -tests. The confidence interval was set at 95%, and the P value was set at ≤0.05. Results: A total of 120 participants were randomized to receive either carbetocin ( n = 60) or oxytocin ( n = 60). The baseline characteristics of the two groups were similar. There was no incidence of PPH in both groups. However, the mean blood loss was significantly lower among women who received carbetocin ( t = −2.72, P = 0.008), and the use of additional uterotonics was significantly higher among women given oxytocin ( χ 2 = 4.62, P = 0.032). The adverse events, including hypotension, shivering, headache, dizziness, and palpitation, were significantly higher among women who received carbetocin ( P < 0.01). Conclusion: Carbetocin and oxytocin are both effective in preventing PPH following vaginal delivery. However, carbetocin is more effective than oxytocin in reducing mean blood loss but associated with more adverse events. We, therefore, recommend carbetocin as an alternative uterotonic for prevention and control of PPH in women during vaginal delivery.