Comparison of Carbetocin, Oxytocin, and Misoprostol for the Prevention of Atonic Postpartum Hemorrhage in High-Risk Women Undergoing Cesarean Delivery in Bangladesh

Open Access

Abstract

Background: Atonic postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, particularly in high-risk women undergoing cesarean delivery. Effective prophylactic uterotonics are critical to prevent excessive blood loss and reduce the need for additional interventions. Aim of the study: To compare the efficacy, safety, and clinical outcomes of carbetocin, oxytocin, and misoprostol in preventing atonic PPH among high-risk women undergoing cesarean delivery in Bangladesh. Methods & Materials: This prospective, randomized, comparative study included 135 high-risk pregnant women scheduled for cesarean section. Participants were assigned to receive carbetocin (100 µg IV), oxytocin (10 IU IV), or misoprostol (800 µg PR) immediately after delivery. Primary outcome was incidence of atonic PPH (≥1000 mL blood loss), with secondary outcomes including severity of PPH, need for additional uterotonics, surgical interventions, and maternal adverse effects. Data were analyzed using ANOVA, Chi-square tests, and relative risk calculation. Results: Carbetocin demonstrated the lowest incidence of PPH (6.67%) compared with oxytocin (13.33%) and misoprostol (11.11%). Carbetocin recipients achieved uterine tone more rapidly, required fewer additional uterotonics and surgical interventions, and experienced fewer adverse effects. Misoprostol was associated with higher rates of fever, shivering, and gastrointestinal symptoms. Relative risk analysis showed a trend favoring carbetocin, though not statistically significant. Conclusion: Carbetocin is the most effective and safe uterotonic for preventing atonic PPH in high-risk cesarean deliveries, offering rapid uterine stabilization and minimal adverse effects. Oxytocin provides moderate efficacy, whereas misoprostol, despite ease of administration, is less tolerable. These findings support preferential use of carbetocin in high-risk cesarean settings in Bangladesh.