Carbetocin versus Oxytocin for Prevention of Postpartum Hemorrhage in Twin Pregnancies Delivered by Cesarean Section: A Randomized Controlled Trial

Abstract

Background: Research from the literature indicates that the likelihood of postpartum hemorrhage (PPH) is one of the most harmful  aspects to take into account when preparing for a twin delivery.

Objective: Our foremost objective was to compare the effectiveness and adverse effects of carbetocin with oxytocin in preventing  postpartum hemorrhage (PPH) in twin pregnant women following elective cesarean section (CS).

Study design: In this randomized controlled study, 118 pregnant women with twin pregnancies who were admitted for an elective  cesarean section in two equal groups, were given intravenous slow IV boluses of carbetocin (group A) and slow intravenous oxytocin  boluses (10 IU) (group B). Following the delivery of the second fetus, all patients were given the study medications.

Results: The need for  additional uterotonics was statistically higher in group B than in group A; 5 (24.3%) versus 15 (13.1%) with P-value 0.025. While the  estimated blood loss was statistically insignificant between both groups (928.5 ± 146.4 ml in (group A) versus 941.2 ±277.2 ml in (group B),  with P-value 0.311. As such, incidence of PPH was statistically insignificantly different between study groups (p value 0.239).  

Conclusion: The use of carbetocin at elective cesarean section for twin pregnancy is not superior to slow IV oxytocin bolus in reducing  the operative blood loss or prevention of PPH but it may reduce the postoperative need for additional uterotonics, especially in IVF twin  gestation.