Background: Primary postpartum hemorrhage (PPH) is a leading cause of maternal mortality, with a global prevalence of approximately 6%. Uterine Atony is the commonest cause of PPH which may occur even without identifiable risk factors. Therefore, WHO recommends universal use of ecbolic drugs in the third stage of labor. Carbetocin, a synthetic heat-stable analog to the standard drug Oxytocin can be used. Whether Carbetocin is more effective is still controversial. In this pilot study, we compared the effectiveness and safety of Carbetocin to Oxytocin in preventing PPH in high-risk women during Cesarean section (CS).

Methodology: 80 participants were randomized to receive an intravenous injection of either 10 IU of Oxytocin or 100 mcg of Carbetocin in the third stage of labor.

Results: Both groups were comparable as regards age, gestational age, pre-operative Hb level, Body Mass Index, parity, number of CS, the presence of risk factors for PPH, and whether in labor or not. There were no differences in the amount of blood loss, the need for extra ecbolic dose, the need for surgical intervention, the need for blood transfusion, or intensive care unit admission. However, Oxytocin arm showed significantly less cost.

Conclusion: Oxytocin is significantly cheaper, which makes it preferable to use in a low-middle-income society, yet this must be tied to availability of optimum storage conditions that guarantee its effectiveness. Further randomized trials with bigger sample sizes and meta-analyses are recommended to test the applicability of our findings in other sites in the country.