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Background <p>Postpartum hemorrhage remains a major cause of maternal morbidity, and cesarean delivery is associated with greater blood loss than vaginal birth. This study evaluated 24-hour bleeding-related outcomes among antenatally low-risk women who received prophylactic oxytocin or carbetocin after National Institute for Health and Care Excellence (NICE) Category 1–2 emergency cesarean delivery and identified intrapartum factors associated with additional uterotonic use.</p> Methods <p>This prospective observational, non-randomized comparative study was conducted between October 2024 and August 2025. Antenatally low-risk women admitted for intended vaginal birth who subsequently required NICE Category 1–2 emergency cesarean delivery received oxytocin 10 IU intravenous (IV) or carbetocin 100&#xa0;µg IV immediately after delivery. The primary outcome was any additional uterotonic use within 24&#xa0;h. Secondary outcomes were tranexamic acid use, hemoglobin decrease ≥ 2&#xa0;g/dL at 24&#xa0;h, absolute hemoglobin change (ΔHb), and postoperative hemoglobin &lt; 8&#xa0;g/dL. Multivariable logistic regression was performed for the primary outcome.</p> Results <p>A total of 300 women were included, with 150 in each group. Additional uterotonic use occurred in 24.0% (36/150) of the carbetocin group and 33.3% (50/150) of the oxytocin group (<i>p</i> = 0.074). Tranexamic acid use did not differ significantly between groups (18.7% vs. 16.0%, <i>p</i> = 0.542). Hemoglobin decrease ≥ 2&#xa0;g/dL occurred in 68.0% and 60.0%, respectively (<i>p</i> = 0.149). Mean ΔHb was 2.49 ± 1.13&#xa0;g/dL in the carbetocin group and 2.38 ± 1.03&#xa0;g/dL in the oxytocin group (<i>p</i> = 0.388). Postoperative hemoglobin &lt; 8&#xa0;g/dL occurred in 11.3% and 12.0%, respectively (<i>p</i> = 0.981). In multivariable analysis, induction/augmentation (adjusted OR 1.92, 95% CI 1.07–3.42, <i>p</i> = 0.028) and longer duration of membrane rupture (adjusted OR 1.23 per doubling, 95% CI 1.06–1.43, <i>p</i> = 0.006) were independently associated with additional uterotonic use, whereas uterotonic group was not (adjusted OR for oxytocin vs. carbetocin 1.51, 95% CI 0.90–2.54, <i>p</i> = 0.122).</p> Conclusions <p>In this prospective observational non-randomized cohort of antenatally low-risk women undergoing emergency cesarean delivery, no statistically significant between-group differences were observed in additional uterotonic use or predefined 24-hour bleeding-related outcomes. Additional uterotonic use was numerically lower with carbetocin, but the difference was not statistically significant. Induction/augmentation and longer duration of membrane rupture were independently associated with higher odds of additional uterotonic use.</p> Trial registration <p>ClinicalTrials.gov (NCT07380529), first submitted on 18 January 2026. Retrospectively registered.</p>

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Carbetocin and oxytocin use in emergency cesarean delivery: a prospective observational study of 24-hour bleeding outcomes

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月11日

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  • Tahir Eryılmaz,
  • Tuğba Kolomuç Gayretli,
  • Selver Özge Şefik,
  • Ayşe Sena Küçükkayıcı,
  • Hüseyin Levent Keskin

摘要

Background

Postpartum hemorrhage remains a major cause of maternal morbidity, and cesarean delivery is associated with greater blood loss than vaginal birth. This study evaluated 24-hour bleeding-related outcomes among antenatally low-risk women who received prophylactic oxytocin or carbetocin after National Institute for Health and Care Excellence (NICE) Category 1–2 emergency cesarean delivery and identified intrapartum factors associated with additional uterotonic use.

Methods

This prospective observational, non-randomized comparative study was conducted between October 2024 and August 2025. Antenatally low-risk women admitted for intended vaginal birth who subsequently required NICE Category 1–2 emergency cesarean delivery received oxytocin 10 IU intravenous (IV) or carbetocin 100 µg IV immediately after delivery. The primary outcome was any additional uterotonic use within 24 h. Secondary outcomes were tranexamic acid use, hemoglobin decrease ≥ 2 g/dL at 24 h, absolute hemoglobin change (ΔHb), and postoperative hemoglobin < 8 g/dL. Multivariable logistic regression was performed for the primary outcome.

Results

A total of 300 women were included, with 150 in each group. Additional uterotonic use occurred in 24.0% (36/150) of the carbetocin group and 33.3% (50/150) of the oxytocin group (p = 0.074). Tranexamic acid use did not differ significantly between groups (18.7% vs. 16.0%, p = 0.542). Hemoglobin decrease ≥ 2 g/dL occurred in 68.0% and 60.0%, respectively (p = 0.149). Mean ΔHb was 2.49 ± 1.13 g/dL in the carbetocin group and 2.38 ± 1.03 g/dL in the oxytocin group (p = 0.388). Postoperative hemoglobin < 8 g/dL occurred in 11.3% and 12.0%, respectively (p = 0.981). In multivariable analysis, induction/augmentation (adjusted OR 1.92, 95% CI 1.07–3.42, p = 0.028) and longer duration of membrane rupture (adjusted OR 1.23 per doubling, 95% CI 1.06–1.43, p = 0.006) were independently associated with additional uterotonic use, whereas uterotonic group was not (adjusted OR for oxytocin vs. carbetocin 1.51, 95% CI 0.90–2.54, p = 0.122).

Conclusions

In this prospective observational non-randomized cohort of antenatally low-risk women undergoing emergency cesarean delivery, no statistically significant between-group differences were observed in additional uterotonic use or predefined 24-hour bleeding-related outcomes. Additional uterotonic use was numerically lower with carbetocin, but the difference was not statistically significant. Induction/augmentation and longer duration of membrane rupture were independently associated with higher odds of additional uterotonic use.

Trial registration

ClinicalTrials.gov (NCT07380529), first submitted on 18 January 2026. Retrospectively registered.