Title : Carbetocin versus conventional uterotonic regimens for prevention of blood loss after vaginal and cesarean delivery: A retrospective study in a Taiwanese low-risk obstetric population
Abstract:
Background: Postpartum Hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, with uterine atony being the primary underlying etiology. Although oxytocin is the standard prophylactic uterotonic agent, carbetocin, a long-acting oxytocin analogue, has emerged as a potential alternative. This study aimed to compare the clinical efficacy of carbetocin with conventional multi-agent uterotonic regimens in reducing peripartum blood loss during vaginal and Cesarean deliveries in a Taiwanese clinical setting.
Methods: This retrospective observational study included 128 patients managed by a single obstetrician. In vaginal deliveries, patients received either carbetocin (100 µg) or a combination regimen consisting of oxytocin, misoprostol, and methylergonovine. In Cesarean deliveries, carbetocin was compared with oxytocin monotherapy. High-risk pregnancies were excluded to ensure a homogeneous low-risk population. Statistical analyses were performed using the Mann–Whitney U test for continuous variables and Fisher’s exact test for categorical variables.
Results: Among vaginal deliveries, the carbetocin group demonstrated significantly lower primary and total blood loss compared with the multi-drug regimen (median: 100 mL vs. 150 mL, P<0.001; 155 mL vs. 200 mL, P=0.047, respectively). In Cesarean deliveries, no statistically significant difference was observed in visually estimated blood loss between groups. However, patients receiving carbetocin exhibited a significantly smaller decline in hemoglobin levels compared with those managed with conventional uterotonics by other physicians (−6.3% vs. −11.93%, P=0.049).
Conclusion: Carbetocin, administered as a single prophylactic agent, is more effective than conventional multi-agent uterotonic regimens in reducing blood loss during vaginal delivery. Additionally, its use is associated with improved hematologic stability in low-risk patients undergoing Cesarean delivery and may reduce variability related to operator-dependent management.
