Systematic use of carbetocin during cesarean delivery of multiple pregnancies: a before-and-after study

Abstract

Cesarean deliveries of multiple pregnancies are associated with a high risk of hemorrhage. The aim of this study is to evaluate the efficacy of carbetocin administered systematically during cesarean deliveries of multiple pregnancies. Single-center retrospective before-and-after study comparing the use of carbetocin to that of oxytocin during cesareans during two consecutive 6-month periods. A composite variable was predefined as the principal endpoint: any one or more of bleeding ≥1,500mL, transfusion, hemoglobin reduction of 4g/dL or more or operative intervention (surgery, embolization). In an intention-to-treat analysis, the comparison of the two groups (n=24 before and n=39 after) showed no difference for the occurrence of the composite variable (16.7 vs. 15.4%, p=0.89). Nor did the per-protocol analysis (n=24 before and n=27 after) differ for it (16.7 vs. 14.8%, p=0.86). Moreover, none of the secondary outcome measures studied-moderate blood loss, prescription of sulprostone, cell-saver use, and intravenous iron infusion-differed significantly between the two periods. In our population of multiple pregnancies delivered by cesarean, carbetocin did not appear more effective than oxytocin in preventing severe postpartum hemorrhage.