Comparative Effectiveness of Carbetocin Versus Oxytocin in Active Management of the Third Stage of Labour for Preventing Atonic Postpartum Haemorrhage: A Study at a Tertiary Care Centre in Central India

Introduction: We aim to determine the comparative effectiveness of heat-stable carbetocin (HSC) versus oxytocin for the prevention of atonic postpartum haemorrhage (PPH) at a tertiary care centre in Central India. Method: This study is a prospective observational study conducted over 18 months (January 2023 to July 2024) and included 284 low-risk gravid women in labour at term after obtaining ethical approval and informed consent. There were 142 participants in each group. Group 1 received heat-stable carbetocin 100 mcg, and group 2 received oxytocin 10 units intramuscularly within one minute of delivery. Women with medical or obstetrical disorders were excluded. The primary objective was to compare the incidence of atonic PPH among participants receiving carbetocin versus oxytocin after the delivery of the baby. The secondary objective was to estimate the mean blood loss (MBL) and change in the haemoglobin (Hb) level before and after delivery in the two groups. Blood loss was estimated by quantifying blood loss by adding up the volumetric component (using a calibrated drape or suction bottle) to the gravimetric estimate. The incidence of PPH and the mean blood loss were noted. The degree of haemoglobin decline before and after delivery was also recorded. Statistical significance was assessed using Student's t-test and chi-square test, and a p-value of <0.05 was taken as significant. Result: The incidence of PPH was comparatively less in women in the carbetocin group (group 1) when compared with those in the oxytocin group (group 2), although not statistically significant (4.2% versus 7%, respectively; p=0.303). A significant difference was observed in the mean blood loss, being less with carbetocin (623±81.3 versus 678±88.7 mL; p=0.039). Haemoglobin decline was also found to be less in those receiving carbetocin (p<0.001). Conclusion: Although insignificant statistically, carbetocin plays an effective role in preventing PPH when compared to oxytocin, particularly in settings where cold chain maintenance for oxytocin transport and storage remains doubtful. Statistically significant lower mean blood loss with carbetocin can be an added advantage.