One dose, big impact: Revisiting carbetocin in high-risk polyhydramnios deliveries.

OBJECTIVE

This study compares the effectiveness and safety of three prophylactic uterotonic regimens-intravenous carbetocin, oxytocin infusion, and oxytocin-ergometrine combination-in preventing postpartum hemorrhage (PPH) in women with isolated polyhydramnios.

METHODS

This retrospective cohort study included 286 term pregnancies complicated by isolated polyhydramnios, managed at a tertiary obstetric center between January 2020 and April 2024. Participants received a single prophylactic uterotonic immediately after placental delivery: carbetocin (n = 124), oxytocin (n = 116), or oxytocin-ergometrine (n = 46). Patients with additional PPH risk factors were excluded. Primary outcomes included hemoglobin and hematocrit changes, estimated blood loss, and 6-h postpartum shock index. Secondary outcomes were rates of transfusion, surgical intervention, and uterine-sparing procedures.

RESULTS

Carbetocin was associated with significantly smaller drops in hemoglobin and hematocrit, lower estimated blood loss, and more favorable shock index values compared to the other groups. These advantages were consistent across cesarean, primiparous, and multiparous vaginal deliveries. Although not statistically significant, fewer secondary interventions (e.g., transfusion, balloon tamponade, and compression sutures) were recorded in the carbetocin group.

CONCLUSION

Among women with isolated polyhydramnios, carbetocin offers superior prophylactic control of PPH compared to oxytocin and oxytocin-ergometrine regimens. Its long-acting effect provides sustained uterine contraction, reducing the need for additional interventions. Carbetocin might be especially beneficial in high-risk cases of uterine overdistension, supporting its targeted use in individualized obstetric care.