Carbetocin vs oxytocin in third stage labour: a quantitative review of low- and middle-income countries

Background/Aims Postpartum haemorrhage is a global concern and is a leading cause of maternal mortality in low- and middle-income countries. Oxytocin is the preferred prophylactic uterotonic; however, it is heat sensitive and therefore may not be suitable in low- and middle-income countries, which are often warm climates. An alternative is carbetocin, which is heat stable and longer acting. 

Methods Literature was sourced from the EBSCO, CINAHL, Medline and Global Health databases. Studies written in English in the last 10 years, that compared carbetocin to oxytocin in management of postpartum haemorrhage were selected. An ABCDFIX mnemonic tool was used to individually critique each study. 

Results The key themes were postpartum haemorrhage over 500ml, postpartum haemorrhage over 1000ml, need for blood transfusion, retained placenta, haemoglobin levels and need for additional uterotonics. The use of carbetocin may reduce the risk of postpartum haemorrhage and the need for additional uterotonics in low- and middle-income countries. 

Conclusions The use of carbetocin, instead of oxytocin, in low- and middle-income countries may reduce the risk of postpartum haemorrhage after vaginal birth and the need for more uterotonics. However, more research is needed in these settings.