Efficacy of Carbetocin vs Oxytocin for Preventing Postpartum Hemorrhage in High-risk Cases: A Randomized Controlled Trial

Aims and background: Postpartum hemorrhage (PPH) significantly contributes to maternal morbidity and mortality, particularly among highrisk obstetric patients.Oxytocin has long been the primary uterotonic agent for preventing PPH.However, growing evidence suggests that carbetocin, a long-acting oxytocin analog, may offer better outcomes due to its prolonged effect and thermal stability.This study evaluates the effectiveness of carbetocin vs oxytocin in managing the third stage of labor to prevent PPH in high-risk women. Materials and methods:Design: A double-blinded, randomized controlled trial was conducted at Pradyumna Bal Memorial Hospital, part of Kalinga Institute of Medical Sciences, Bhubaneswar.Population/sample: The study included 486 high-risk pregnant women randomly assigned to two groups.Interventions: Group A (243 women) received 10 IU of oxytocin, while group B (243 women) received 100 g of carbetocin intravenously immediately following delivery, along with standard active management of the third stage.Primary outcomes: Need for additional uterotonics.Secondary outcomes: Blood loss, hemoglobin levels, hemodynamic changes, uterine tone, and adverse effects such as nausea, vomiting, and hypotension.Results: Carbetocin significantly reduced the requirement for additional uterotonics (28.40%) compared to oxytocin (55.97%), with statistical significance (p < 0.05).It also resulted in improved uterine tone at 5 and 30 minutes post-delivery.Although blood loss was slightly lower in the carbetocin group, the difference was not statistically significant.Both medications exhibited comparable safety profiles, with no notable disparities in adverse effects.Conclusion: Carbetocin appears to be a superior alternative to oxytocin, particularly in high-risk cases, due to its prolonged action and stability.Its potential as a preferred option for PPH prevention, even in resource-limited settings, warrants further consideration.