From the Research
Carbetocin is preferred over oxytocin for preventing postpartum hemorrhage during lower segment cesarean section (LSCS) due to its longer half-life and reduced need for additional uterotonics, as shown in a 2019 systematic review and meta-analysis 1. The main advantage of carbetocin is its extended duration of action, which eliminates the need for continuous infusion and reduces the risk of medication errors. Studies show carbetocin provides comparable or superior uterine contraction with less need for additional uterotonics, as seen in a 2020 prospective observational study 2. However, both medications share similar side effect profiles including hypotension, nausea, vomiting, and flushing. Carbetocin's main disadvantage is its higher cost, though this may be offset by reduced nursing time and decreased need for additional medications. For patients with preeclampsia or cardiovascular disease, slower administration of either medication is recommended to minimize hypotensive effects. Some key points to consider when choosing between carbetocin and oxytocin include:
- Carbetocin requires a single 100 mcg IV dose, while oxytocin typically requires an initial 5-10 IU IV bolus followed by a continuous infusion
- Carbetocin has a longer half-life than oxytocin, reducing the need for additional uterotonics
- Carbetocin is associated with less blood loss and fewer adverse effects compared to syntometrine, as shown in a 2012 Cochrane review 3
- The cost-effectiveness of carbetocin is still being researched, but it may be offset by reduced nursing time and decreased need for additional medications. Overall, carbetocin is a preferred option for preventing postpartum hemorrhage during LSCS due to its efficacy, safety, and convenience, as supported by the most recent and highest quality study 1.