Abstract
BACKGROUND: Prevention of postpartum hemorrhage is imperative due to its impact on maternal morbidity and death. Uterine atony is regarded as the predominant cause of postpartum hemorrhage. Preventive use of uterotonic agents is one of the most important steps in the active management of the third stage of labor to prevent postpartum hemorrhage. A common first-line drug for prevention is oxytocin. This study observes and compares the effects of carbetocin, a long-acting synthetic analogue of oxytocin. The purpose of this study is to determine and compare the efficacy and requirement of additional drugs and procedures. Since carbetocin is more expensive than oxytocin, the cost-effectiveness is assessed as well in this study. METHODS: This study randomly enrolled a total of 145 women admitted for delivery, including those at high risk for postpartum hemorrhage. group A consisted of 73 women who received an injection of carbetocin, and group B consisted of 72 women who received an injection of oxytocin. Parameters that were observed were visual estimation of total blood loss post-delivery, time taken for uterine tone, need for additional uterotonic drugs, additional procedures, drop in hemoglobin level, requirement for blood transfusion, ICU admission, specialist consultation, and additional investigations. The cost-effectiveness was also assessed on the basis of the total cost of all additional procedures, drugs, length of hospital stay, and blood transfusions. We analyzed the data using SPSS Version 29 (IBM Corp., Armonk, NY, USA). RESULTS: The present study observed that group A (carbetocin) had a lower incidence of postpartum hemorrhage, four (5.5%), compared to group B (oxytocin), 16 (22.2%). In group A, 38 women (52%) attained uterine tone in less than 30 seconds, compared to 12 women (16.7%) in group B. Blood loss of less than 500 mL occurred in 18 women (24.7%) who received carbetocin and in 12 women (16.7%) who received oxytocin. Group B showed a greater decline in hemoglobin and blood pressure post-delivery. Only 13 (17.8%) of women in group A received additional uterotonics, compared to 41 (56.9%) in group B. Seven (9.7%) in group B required additional procedures, as compared to three (4.1%) in group A. Carbetocin had an overall reduced cost as compared to oxytocin. CONCLUSION: Carbetocin is superior to oxytocin in limiting postpartum hemorrhage, and a similar safety profile is available as a room-temperature-stable formulation. In addition, carbetocin shows several advantages, like significantly reducing the need for additional uterotonics, procedures, blood transfusions, and longer hospital stays, making it an overall cost-effective drug.