Intramyometrial and Intravenous Oxytocin Compared With Intravenous Carbetocin for Prevention of Postpartum Hemorrhage in Elective Cesarean Section: A Quasirandomized Controlled Phase IV Noninferiority Interventional Trial

( Acta Obstet Gynecol Scand . 2024;103(9):1838–1846. DOI: 10.1111/aogs.14893) Maternal morbidity and mortality have a significant global burden, and nearly 25% of all maternal deaths worldwide are caused by postpartum hemorrhage (PPH). Blood loss of 500 mL or more within 24 hours of birth constitutes PPH according to the World Health Organization (WHO), and a cumulative blood loss of >1000 mL constitutes PPH according to the American College of Obstetricians and Gynecologists and a few other countries. The most common cause of PPH is uterine atony. The WHO recommends oxytocin for PPH prevention, and carbetocin is recommended in contexts where it is comparable in cost. Current evidence is conflicting when comparing the 2, with several studies showing that carbetocin reduces the need for other uterotonic agents. This study was designed to remove a great deal of heterogeneity present in previous studies and evaluate noninferiority of combined application of oxytocin (10 IU oxytocin bolus IM+10 IU IV infusion) to carbetocin 0.1 mg IV in preventing severe PPH as defined by a decrease in hemoglobin (Hb) of 30 g/L or more.