Carbetocin vs Oxytocin for the Prevention of Postpartum Hemorrhage in High-risk Women: A Prospective Study

Introduction: Uterotonics for prevention of postpartum hemorrhage (PPH) are recommended for all deliveries, and a synthetic, heat-stable substitute of oxytocin with a longer half-life, carbetocin, has recently been approved to be used in India. Methodology:We planned a prospective comparative study evaluating the efficacy and safety of oxytocin and carbetocin for the prophylaxis of PPH.This study was conducted at Mahatma Gandhi Medical College & Hospital, Jaipur, and included all term pregnant patients in labor, with a high risk of PPH.A total of 200 participants were randomized, group A receiving carbetocin (100 g intravenous over 2 minutes), and group B receiving oxytocin (10 IU intramuscular) immediately after delivery of the newborn.Different maternal and neonatal parameters related to PPH and side effects were noted.Results: Age, socioeconomic status, body mass index, onset, and duration of labor of participants in both groups were comparable.The significant differences obtained were those in blood loss (p-value: 0.004) and hemoglobin levels after delivery (p-value: 0.001).The need for additional uterotonics postpartum was less with carbetocin 11.8%, as compared to oxytocin 33.8%.Side effects and neonatal outcomes of both uterotonics were the same in both groups. Conclusion:This study demonstrates that heat-stable, long-acting carbetocin is superior to oxytocin in reducing blood loss and minimizing the need for additional uterotonics during delivery, though the side effects and neonatal outcomes were similar.These findings support the preferential use of carbetocin in preventing PPH among high-risk women, thereby potentially improving maternal health outcomes in clinical practice.