Comparison of Prevention of Postpartum Hemorrhage Using Carbetocin vs Oxytocin in Cesarean Section: An Open-label Randomized Clinical Trial in Central India

Introduction:Oxytocin is still the most commonly used uterotonic agent worldwide.However, carbetocin, which is a long-acting oxytocin analog, is being used more frequently.Apart from being costlier, it is still doubtful whether carbetocin is a significantly better uterotonic agent than oxytocin.The aim of the study was to compare the effect of prophylactic intravenous bolus carbetocin (100 g) and slow intravenous oxytocin 10 IU in the prevention of postpartum hemorrhage (PPH) in patients undergoing lower-segment cesarean section and to assess the blood loss in both groups and compare the safety and adverse effects in both groups. Materials and methods:An open-label randomized controlled trial was conducted in SSIMS, Bhilai, where a total of 352 participants were randomly divided into two groups, with 176 participants in each group.One group received 10 IU of oxytocin diluted with 8 mL normal saline, and the other group received carbetocin 100 g intravenous bolus immediately after the delivery of the neonate. Results:The mean blood loss in the carbetocin group was significantly higher than the oxytocin group (p < 0.016).The number of blood transfusions was higher in the carbetocin group, and the proportion of patients requiring additional uterotonics in the carbetocin group (48.86%) was higher as compared to the oxytocin group (7.95%) (Chi-square value: 72.41) (p < 0.001).Though the oxytocin group had significant intraoperative tachycardia and hypotension as compared to carbetocin, it reverted back to the preinterventional state within 10 minutes.Conclusion: Compared to carbetocin, intravenous bolus 10 IU oxytocin is a better and cost-effective drug with reduced requirement of additional uterotonics in the prevention of PPH in cesarean section.The only adverse effect of oxytocin being immediate intraoperative hypotension and tachycardia within 1 minute, but it normalizes by 10 minutes.