Prophylactic carbetocin versus oxytocin following vaginal delivery among women with high risk for postpartum hemorrhage: A before-and-after study.

introductionData with a high level of evidence is lacking on the use of prophylactic uterotonic drug following vaginal delivery to prevent postpartum hemorrhage (PPH) among women who were considered high-risk for PPH. Our main objective was to compare the effectiveness of prophylactic carbetocin versus oxytocin in preventing PPH after vaginal delivery among women at high risk. MATERIAL AND

methodsWe conducted a retrospective before-and-after single-center comparative study, including all high-risk women after vaginal births. Two consecutive 14-month periods were compared, where the prophylactic methods to prevent PPH differed: oxytocin (5 IU IV) versus carbetocin (100 μg IV) given immediately after vaginal delivery. High-risk women were defined by at least one of the following criteria: previous PPH (blood loss ≥500 mL), antenatal suspicion of macrosomia (estimated fetal weight >90th p), twin pregnancy, repeated cervical ripening methods, polyhydramnios, multiparity (≥4), and rapid labor (<2 h) without analgesia. The primary outcome was PPH. Secondary outcomes included severe PPH (blood loss ≥1000 mL), second-line uterotonic agents, surgical hemostatic procedures, uterine artery embolization, and maternal morbidity. Groups were matched 1:1 by risk criteria. Outcomes were assessed using univariate analysis, multivariable logistic regression, and propensity score adjustment.

resultsA total of 754 women (377 per group) were included. Maternal and labor characteristics were comparable. Rates of PPH and severe PPH were similar with carbetocin versus oxytocin (7.4% vs. 9.3%, p = 0.36; 2.9% vs. 2.7%, p = 0.83). The need for second-line uterotonics (additional oxytocin and/or sulprostone) was significantly lower with carbetocin (3.7% vs. 12.2%, p < 0.001). Other secondary outcomes did not differ. After adjustment for potential confounders (history of PPH, BMI, intrapartum fever), prophylactic carbetocin was not associated with increased risk of PPH (aOR = 1.85, 95% CI [0.97 to 3.57]). Propensity score analysis confirmed these findings (aOR = 1.33, 95% CI [0.74 to 1.72]).

conclusionsProphylactic carbetocin was associated with a similar rate of PPH in high-risk women after vaginal delivery, compared with oxytocin, but significantly reduced the use of oxytocin when carbetocin was used as the first-line agent, although there was no difference in the use of prostaglandins or invasive procedures to manage persistent PPH.