Carbetocin for Postpartum Haemorrhage Prophylaxis in All Births: A Retrospective Cohort Study Following Policy Change in Routine Uterotonic Use.

Abstract

To compare postpartum haemorrhage (PPH) outcomes following a change in routine prophylactic uterotonic from Oxytocin to Carbetocin. A retrospective cohort study with a before-after design. A large tertiary maternity service in Melbourne, Australia. All births that met the inclusion criteria (n = 6235) from January to June 2020 and 2021. Clinical outcome data for all births in the two 6-month periods were retrieved from the electronic medical records and manually checked for accuracy. Data were statistically analysed using univariate tests and binary logistic regression. Weighed blood loss (mL) and prevalence of moderate (≥ 500 mL) and severe (≥ 1000 mL) PPH. Secondary outcomes included use of additional uterotonics, blood transfusions, admission to the high-dependency care unit, and length of stay. Carbetocin was associated with significantly lower average blood loss (p < 0.001), including rates of moderate and severe PPH (p < 0.001). There were no significant differences in the use of additional uterotonics or blood transfusions following the implementation of Carbetocin. There were significant reductions in admissions to the high-dependence care unit and length of hospital stay. Secondary analyses identified that Carbetocin was associated with reduced odds of PPH for both vaginal and caesarean birth after adjusting for a range of factors that increase the risk of PPH. Carbetocin is associated with reduced blood loss and the rate of PPH compared to Oxytocin. Associated reductions in admissions to high dependency care and length of hospital stay are likely to result in reduced maternal morbidity and lower hospital costs.