Carbetocin versus Oxytocin in the prevention of postpartum haemorrhage in caesarean section:A Prospective Randomized Comparative Study

Abstract Background: Postpartum haemorrhage is the leading cause of maternal mortality. The prevention of PPH can be best done by active management of third stage of labour. Oxytocin is currently the uterotonic of choice. Purpose: The purpose of the study was to compare the efficacy of Carbetocin 100 mcg intravenous and Oxytocin 10 IU intravenous infusion over 2 hours by measuring the total blood loss, need for additional uterotonic agents and need for blood transfusion. It is important to evaluate the efficacy of carbetocin compared to oxytocin in low income countries and especially in places where affordability of patients are a major concern. Method: A prospective randomized comparative single blinded study was carried out in the department of obstetrics and Gynaecology, Kurji Holy Family hospital, Patna, Bihar. Total 100 patients undergoing elective cesarean section fitting in the inclusion criteria were randomly allocated by sealed envelope system to either case study group A receiving Carbetocin 100 mcg intravenous and control study group B receiving Oxytocin 10 IU intravenous infusion. Three specific outcomes were measured: total blood loss, additional uterotonic use and the need for blood transfusion. Results: In this study, Carbetocin was found to significantly reduce the total blood loss in comparison to oxytocin(p<0.0001), use of additional uterotonics was significantly less in Carbetocin group (p=0.023) , need for blood transfusion was less in Carbetocin group but not significantly (p=0.538). Conclusion: Carbetocin has better efficacy in comparison to oxytocin in reducing the total blood loss, hence preventing PPH. The need for additional uterotonic agents is a less with Carbetocin use. The need for blood transfusion was also less with Carbetocin use but needs larger studies to be proved. Reduction in re-treatment , staffing requirements ,transfusion ,potential medication errors mitigate the higher index cost of Carbetocin. From a pharmacoeconomic perspective, in the context of cesarean section. Carbetocin may be cost-effective.