Abstract
(Int J Obstet Anesth. 2019;40:4–23) Uterine atony is the most common (70%) cause of postpartum hemorrhage (PPH). While oxytocin has been shown to effectively treat PPH, rescue uterotonics are needed in as many as 13% of women undergoing elective cesarean delivery (CD) to achieve adequate uterine tone. Some studies have suggested carbetocin is superior to oxytocin in minimizing blood loss and the need for additional uterotonics, although systematic reviews examining its ability to reduce the incidence of PPH have yielded varied results. These reviews have included both emergency and elective CDs, however, and have been limited by their traditional meta-analysis structure. This review used trial sequential analysis (TSA), which has been shown to prevent false-positive results, to compare carbetocin with oxytocin for its effectiveness in the prevention of uterine and PPH during elective CD.
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