Carbetocin vs oxytocin for prevention of postpartum hemorrhage in women with obesity undergoing cesarean delivery: A systematic review and meta-analysis.

OBJECTIVE

To compare the effectiveness and safety of carbetocin versus oxytocin for the prevention of postpartum hemorrhage in women with obesity undergoing cesarean delivery.

STUDY

DESIGN

PubMed, CENTRAL, and Embase databases were searched from inception through July 2025, with no language restrictions. Randomized controlled trials were included. Outcomes assessed were mean blood loss, need for blood transfusion, use of additional uterotonics, hemodynamic parameters, and adverse events. Random-effects meta-analyses were performed in R software. Continuous outcomes were pooled as mean differences (MD), and binary outcomes as risk ratios (RR). Statistical heterogeneity was assessed using the I² statistic.

RESULTS

Three RCTs (n = 269 participants) were included. Carbetocin was associated with a greater reduction in blood loss than oxytocin (MD -230.11 ml; 95% CI -370.90 to -89.33; p = 0.0014), and significantly fewer blood transfusions when compared to oxytocin (RR 0.14; 95% CI 0.03 to 0.63; p = 0.011); although these results lacked robustness in sensitivity analysis. However, in the pooled and sensitivity analyses, carbetocin demonstrated a significant and consistent reduction in the incidence of postpartum hemorrhage (RR 0.19; 95% CI 0.06 to 0.63; p = 0.006).

CONCLUSIONS

Carbetocin was associated with significantly reduced incidence of postpartum hemorrhage compared with oxytocin in obese women undergoing cesarean delivery. These findings suggest potential benefit of carbetocin in this high-risk population; however, larger, high-quality trials are required to confirm these results.