Publication:

Carbetocin versus oxytocin in active management of third stage of labor: a randomized controlled trial

Background Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality. Active management of the third stage of labor (AMTSL) using uterotonic agents significantly reduces the incidence of PPH. Oxytocin is the most commonly used uterotonic; however, its short duration of action may necessitate repeated dosing. Carbetocin, a long-acting oxytocin analogue, offers sustained uterine contraction with a single dose.

Methods A single-blind randomized controlled trial was conducted at a tertiary care center over 18 months. A total of 200 pregnant women with singleton or multiple pregnancies ≥32 weeks of gestation undergoing vaginal delivery or cesarean section were enrolled. Participants were randomly allocated into two groups: the carbetocin group (100 µg intravenous single dose) and the oxytocin group (10 IU intramuscular or 20 IU intravenous infusion). The primary outcomes assessed were blood loss within 24 hours postpartum, uterine tone, and requirement of additional uterotonics. Secondary outcomes included changes in hemoglobin levels, need for blood transfusion, hemodynamic changes, and drug-related adverse effects.

Results Mean blood loss in the 1st 24 hours postpartum was significantly lower in the carbetocin group compared to the oxytocin group (398±138.52 ml versus 467±189.65 ml; p=0.004). Fewer women in the carbetocin group required additional uterotonic agents. Post-delivery hemoglobin levels were significantly higher in the carbetocin group. No significant adverse effects were observed in either group.

Conclusions Carbetocin is more effective than oxytocin in reducing postpartum blood loss during active management of the third stage of labor, with the added advantage of single-dose administration and a comparable safety profile. Carbetocin can be considered a suitable alternative to oxytocin, particularly in tertiary care and high-risk obstetric settings.