Effects of Stepwise Carbetocin Administration on Postpartum Hemorrhage after Prelabor Cesarean Delivery

Abstract

Objective: To evaluate the effectiveness of stepwise administration of carbetocin in reducing postpartum hemorrhage (PPH) in term pregnancies undergoing elective cesarean delivery. Materials and Methods: This study included term pregnancies scheduled for cesarean delivery. Exclusion criteria were a BMI ≥ 35 kg/m2 , any underlying medical conditions that contraindicated the use of carbetocin and conditions affecting uterine contraction. Following newborn delivery, an initial dose of 50 µg of carbetocin was administered, with a subsequent 50 µg given if uterine contraction was inadequate. The primary outcome was the incidence of PPH exceeding 500 mL, while secondary outcomes included total blood loss ≥ 1,000 mL, administration of additional uterotonic agents, adverse effects, other pregnancy-related and surgical outcomes. Results: Of the 152 pregnant women analyzed, adequate uterine contraction was observed in 69.7% of cases after the first carbetocin dose, with an additional 19.7% achieving adequate contraction after the second dose. Estimated blood loss exceeding 500 mL was 32.9% and exceeding 1,000 mL was 2.0% of cases, respectively. Recalculations based on pre- and post-hematocrit levels indicated higher rates of blood loss: more than 500 mL in 45.4% and over 1,000 mL in 13.8%. No serious adverse events or complications were reported. Conclusion: The stepwise regimen demonstrated an effectiveness of 69.7% in preventing postpartum hemorrhage (PPH) during elective cesarean deliveries with the initial 50 µg dose, which increased to 89.4% following the administration of a second dose.