Authors: (including presenting author): :
Li KTJ (1), Lee LLT (1), LW Chan (1)
Affiliation: :
(1) Department of O&G, Pamela Youde Nethersole Eastern Hospital
Keyword 2: :
Caesarean Section
Keyword 3: :
Postpartum Haemorrhage/prevention & control
Keyword 4: :
Retrospective Studies
Introduction: :
Oxytocin had been the most commonly used uterotonic for PPH prophylaxis in cesarean sections (CS), while carbetocin has been advocated as an alternative in recent years. It may be more beneficial in those with risk factors for PPH, such as multiple pregnancy and placenta previa / accreta spectrum. Given the substantially higher cost of carbetocin compared to oxytocin, selective use in high-risk populations may represent a more rational strategy.
Objectives: :
To assess the effectiveness of a universal use strategy of carbetocin in all CSs, compared to a selective use strategy for CSs with risk factors for postpartum haemorrhage (PPH).
Methodology: :
This was a retrospective before-and-after study involving all patients who delivered via CS in our unit. From 1 January 2021 to 12 November 2023 (“selective use”), carbetocin was used in high-risk CS cases only. From 13 November 2023 to 30 June 2025 (“universal use”), carbetocin was given to all CS cases.
Result & Outcome: :
Both estimated blood loss (EBL) and incidence of postpartum haemorrhage significantly increased with universal use. Operative EBL increased from 429.3mL to 461.2mL (mean difference (MD) +31.9mL, 95% confidence interval (CI) +1.4 to +62.4mL, p=0.040*). Incidence of PPH increased from 27.2% to 33.2% (odds ratio (OR) 1.329, CI 1.087 to 1.624, p=0.005*). Incidence of major PPH (>1000mL) and blood transfusion increased but did not reach statistical significance. There was no statistically significant difference in mean postoperative hemoglobin change between the two groups. (-1.501g/dL vs -1.474g/dL, p=0.552) Universal use was also associated with increased use of additional oxytocin (0.8% vs 3.1%, OR 4.135, CI 1.903 to 8.986, p< 0.001*) and tranexamic acid (3.9% vs 6.4%, OR 1.694, CI 1.1 to 2.578, p=0.013*). Operation time was significantly increased (55.0min vs 59.2min, p< 0.001*), while postoperative stay was also longer (4.9 days vs 5.1 days, p=0.024*). A universal use strategy of using carbetocin in all CSs was not superior to a selective use strategy, where carbetocin is reserved to those with PPH risk factors. Given the higher cost of carbetocin, selective use may be more appropriate.
