A Comparative Study of Carbetocin and Oxytocin in Placental Separation and Postpartum Hemorrhage Control Following Vaginal and Cesarean Deliveries.

BACKGROUND

Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. Timely placental separation and effective uterotonic therapy are critical components in the prevention and management of PPH. Oxytocin has been the gold standard for uterotonic use; however, newer agents such as carbetocin offer longer duration of action and may improve maternal outcomes. Comparative evaluation of these agents in both vaginal and cesarean deliveries is essential for optimizing clinical protocols.

AIM: The aim of this study was to compare the efficacy of carbetocin and oxytocin in promoting placental separation and controlling PPH following normal vaginal delivery (NVD) and lower segment cesarean section (LSCS).

METHODOLOGY: This prospective, comparative observational study was conducted at the Department of Obstetrics and Gynaecology, Dr. D. Y. Patil Medical College, Pune, over a period of 2 years from November 2022 to October 2024. A total of 200 women were enrolled and divided equally into two groups: Group A received 100 μg of intravenous carbetocin, and Group B received 10 IU of intravenous oxytocin. Each group included an equal number of women undergoing NVD and LSCS. Outcomes assessed included time for placental separation, duration of the third stage of labor, estimated blood loss, requirement for additional uterotonics, and incidence of PPH.

RESULTS

The mean time to placental separation and third-stage duration were significantly shorter in the carbetocin group compared to the oxytocin group. Carbetocin was also associated with reduced intraoperative and postpartum blood loss and a lower need for additional uterotonic agents. The incidence of atonic PPH was notably lower in the carbetocin group, both in vaginal and cesarean deliveries.

CONCLUSION

Carbetocin is more effective than oxytocin in achieving faster placental separation, reducing third-stage labor duration, minimizing blood loss, and lowering the risk of atonic PPH in both normal and operative deliveries. Its longer duration of action and reduced need for repeat dosing make it a superior uterotonic agent for PPH prophylaxis.