International journal of obstetric anesthesia · 2026
Carbetocin versus oxytocin for the prevention of uterine atony during cesarean delivery: a real-world retrospective historical control cohort study (2022-2023).
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Binyamin Yair, Kviat Karina, Heesen Philip, Azem Karam, Assor Emma Lee, Frenkel Amit, Orbach-Zinger Sharon
Аннотация
BACKGROUND: Oxytocin is widely used for prevention of postpartum hemorrhage, whereas carbetocin provides a longer uterotonic effect. We compared their effectiveness as routine prophylaxis during cesarean delivery.
METHODS: We conducted a retrospective before-and-after cohort study at a single academic center. Women undergoing cesarean delivery received oxytocin (3-5 IU bolus followed by 20 IU in 1000 mL over 3 h) during the first study period (February-April 2022) or carbetocin (100 µg bolus) during the second period (February-April 2023). All consecutive cesarean deliveries were included; patients with missing outcome data or protocol deviations were excluded. Primary outcome was need for additional uterotonics. Secondary outcomes included postoperative change in hemoglobin (measured within 24 ± 6 h), packed red blood cell transfusion, intensive care admission, relaparotomy, and length of hospital stay. Groups were compared with univariable tests, and multivariable logistic regression estimated the independent association of treatment with additional uterotonics.
RESULTS: We identified 1,349 cases; 659 received oxytocin and 690 received carbetocin. Additional uterotonics were used in 32.2% (212/659) in the oxytocin group vs. 20.4% (141/690) in the carbetocin group (P < 0.001). The oxytocin group was associated with a greater median postoperative hemoglobin decrease (1.2 g/dL [IQR 0.6-2.0] vs. 1.0 g/dL [IQR 0.4-1.6]; P < 0.001), though this 0.2 g/dL difference is of uncertain clinical significance. Red blood cell transfusion occurred in 4.2% (28/659) of oxytocin cases vs. 2.2% (15/690) of carbetocin cases (P = 0.030). In adjusted analysis, carbetocin was associated with lower odds of additional uterotonics administration compared with oxytocin (OR 0.53, 95% CI 0.41-0.68; P < 0.001).
CONCLUSIONS: In this single-center retrospective cohort, carbetocin was associated with reduced administration of additional uterotonics, a lower decrease in postoperative hemoglobin, and reduced transfusion compared with an oxytocin regimen of single bolus plus infusion during cesarean delivery. While these associations were statistically robust after adjustment for measured confounders, the before-and-after study design and potential unmeasured confounding limit causal inference. These findings support carbetocin as an effective option for PPH prophylaxis during cesarean delivery, particularly in settings where sustained uterotonic effect from a single bolus is desirable, though confirmation through randomized trials in diverse settings would strengthen the evidence base.
METHODS: We conducted a retrospective before-and-after cohort study at a single academic center. Women undergoing cesarean delivery received oxytocin (3-5 IU bolus followed by 20 IU in 1000 mL over 3 h) during the first study period (February-April 2022) or carbetocin (100 µg bolus) during the second period (February-April 2023). All consecutive cesarean deliveries were included; patients with missing outcome data or protocol deviations were excluded. Primary outcome was need for additional uterotonics. Secondary outcomes included postoperative change in hemoglobin (measured within 24 ± 6 h), packed red blood cell transfusion, intensive care admission, relaparotomy, and length of hospital stay. Groups were compared with univariable tests, and multivariable logistic regression estimated the independent association of treatment with additional uterotonics.
RESULTS: We identified 1,349 cases; 659 received oxytocin and 690 received carbetocin. Additional uterotonics were used in 32.2% (212/659) in the oxytocin group vs. 20.4% (141/690) in the carbetocin group (P < 0.001). The oxytocin group was associated with a greater median postoperative hemoglobin decrease (1.2 g/dL [IQR 0.6-2.0] vs. 1.0 g/dL [IQR 0.4-1.6]; P < 0.001), though this 0.2 g/dL difference is of uncertain clinical significance. Red blood cell transfusion occurred in 4.2% (28/659) of oxytocin cases vs. 2.2% (15/690) of carbetocin cases (P = 0.030). In adjusted analysis, carbetocin was associated with lower odds of additional uterotonics administration compared with oxytocin (OR 0.53, 95% CI 0.41-0.68; P < 0.001).
CONCLUSIONS: In this single-center retrospective cohort, carbetocin was associated with reduced administration of additional uterotonics, a lower decrease in postoperative hemoglobin, and reduced transfusion compared with an oxytocin regimen of single bolus plus infusion during cesarean delivery. While these associations were statistically robust after adjustment for measured confounders, the before-and-after study design and potential unmeasured confounding limit causal inference. These findings support carbetocin as an effective option for PPH prophylaxis during cesarean delivery, particularly in settings where sustained uterotonic effect from a single bolus is desirable, though confirmation through randomized trials in diverse settings would strengthen the evidence base.