Evaluation of carbetocin and oxytocin for prevention of postpartum hemorrhage in women undergoing cesarean delivery at Jaramogi Oginga Odinga Teaching and Referral Hospital, Kenya

Abstract

Background: Postpartum hemorrhage (PPH) is the leading direct cause of maternal mortality and morbidity globally and locally. Use of  uterotonics specifically oxytocin, for prevention of PPH in all births is recommended by the World Health Organization (WHO). Although  oxytocin is readily and widely available at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) and is currently the  preferred uterotonic for all births, there is paucity of data on its effectiveness.

Objective: To evaluate the effectiveness of oxytocin in the form of comparative study with its analogue, carbetocin for prevention of PPH  in women undergoing cesarean delivery at JOOTRH.

Methods: This was a quasi-experimental trial with154 women, 77 in each arm recruited in the study. The intervention arm received  100mcg Carbetocin, the control arm received 10IU oxytocin. Variables of interest were use of additional uterotonics, estimated blood loss,  and need for transfusion. Propensity score matching and binary logistic regression analysis were employed to assess the relationship between the study arm and variables of interest. Covariates with pvalue <0.05 were considered significant.

Results:  Participants in the oxytocin group were 8 times more likely to receive additional uterotonics (OR=8.00, 95% CI 3.77,18.2, P-value<0.001).  There was no statistically significant difference in blood loss (P-value 0.387) and need for transfusion (P-value 0.229).

Conclusion:  Carbetocin was noted to be more effective in PPH prevention as its use was associated with reduced need for additional uterotonics. Recommendation: Carbetocin should be included as a first line agent in PPH prophylaxis in women undergoing cesarean delivery.