Carbetocin evaluated against oxytocin to prevent postpartum hemorrhage in twin pregnancies

Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, with its incidence significantly elevated in twin pregnancies. The overdistension of the uterus in multiple gestations increases the risk of uterine atony, where the uterus fails to contract adequately after childbirth, leading to excessive bleeding. Current standard care often relies on oxytocin, a uterotonic agent, but its efficacy can be limited by a short half-life and potential for tachyphylaxis with prolonged use. This necessitates exploring more potent or longer-acting alternatives to improve PPH prevention, especially in high-risk populations like those carrying twins, where blood loss can quickly become life-threatening and require transfusions or more invasive procedures.

This randomized clinical trial enrolled 200 participants with twin pregnancies, assigning them to receive either carbetocin or standard oxytocin immediately after the delivery of the second twin. The study design aimed to compare the efficacy of carbetocin against standard oxytocin in preventing postpartum hemorrhage following both vaginal and cesarean deliveries. The primary endpoint for evaluating blood loss was the measurement of hemoglobin levels before delivery and on the day after delivery, quantifying the drop as an indicator of hemorrhage severity. Participants were also closely monitored during their hospital stay and for up to six weeks post-delivery to assess safety outcomes and any adverse events associated with either treatment.