A Meta-analysis on the Comparison of Carbetocin Versus Oxytocin on Additional Uterotonic Use, Incidence of Postpartum Hemorrhage, and Need for Blood Transfusion after Cesarean Section under Neuraxial Anesthesia

Abstract

ABSTRACT Postpartum hemorrhage (PPH) remains to be the leading cause of maternal deaths worldwide. The first-line treatment in its prevention is the administration of uterotonics before the delivery of the placenta. Recently, a newer synthetic analog has been developed – carbetocin. With its introduction, new questions arise as to which is more effective in preventing PPH. Four major electronic databases were searched for randomized controlled trials comparing carbetocin and oxytocin in terms of additional uterotonic use, incidence of PPH, and need for blood transfusion. Only randomized controlled studies involving pregnant women undergoing cesarean section under regional anesthesia were included. Outcomes included are the need for additional uterotonic use, the incidence of PPH, and the need for blood transfusion. Of the three outcomes, carbetocin was found to show statistically significant protection against the need for additional uterotonic administration and the need for blood transfusion. Results showed that carbetocin provided a statistically significant risk reduction for the need for additional uterotonics (risk ratio [RR] = 0.53, 95% confidence interval [CI] 0.46–0.81, P < 0.00001) and need for blood transfusion (RR = 0.34, 95% CI 0.19–0.62, P = 0.0004). Need for additional uterotonics and for blood transfusion was found to be almost twice (1/0.53 = 1.88) and almost thrice (1/0.34 = 2.94) as likely, respectively, to occur in the oxytocin group versus the carbetocin group. Reduction of PPH pointed toward carbetocin providing greater protection against it, but it was found not to be statistically significant (RR = 0.85, 95% CI 0.56–1.28, P = 0.43).