Comparison of Efficacy of Carbetocin and Oxytocin in Prevention of Postpartum Hemorrhage Following Normal Vaginal Delivery

Abstract Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality globally, with uterine atony being its most frequent etiology. Although oxytocin is the first-line agent for prophylaxis, its short half-life limits its utility. Carbetocin, a long-acting oxytocin analog, offers potential advantages. Objective: To compare the efficacy and safety of carbetocin versus oxytocin in preventing PPH among women undergoing normal vaginal delivery. Methods: A double-blinded randomized controlled trial was conducted at BRD Medical College, Gorakhpur, from November 2022 to October 2023. A total of 209 women aged 20–35 years with singleton term pregnancies undergoing uncomplicated vaginal deliveries were randomly assigned to receive either 100 mcg IV carbetocin (n=102) or 10 IU IM oxytocin (n=107) during active management of the third stage of labor. Primary outcomes included blood loss, uterine tone, need for additional interventions, and hemoglobin deficit. Secondary outcomes assessed were hospital stay >3 days and ICU admissions. Results: Mean blood loss was significantly lower in the carbetocin group (289.84 ± 100.3 mL) compared to the oxytocin group (384 ± 211.5 mL; p<0.001). Carbetocin group showed significantly reduced need for blood transfusion (6.9% vs 16.8%; p=0.027), uterine massage (5.9% vs 28.0%; p<0.001), and balloon tamponade (1.0% vs 11.2%; p=0.003). Hemoglobin deficit was lower in the carbetocin group (0.396 vs 0.524 g/dL; p<0.001), and fewer patients required extended hospital stay (p=0.002). Conclusion: Carbetocin was significantly more effective than oxytocin in reducing blood loss, minimizing the need for further uterotonics and interventions, and shortening hospital stay following normal vaginal delivery. These findings support the use of carbetocin as a superior alternative to oxytocin in routine PPH prophylaxis.