Oxytocin Infusion after Oxytocin Bolus and Carbetocin Bolus to Reduce Blood Loss During and after Cesarean Section - A Randomized Clinical Trial

Objectives: The aims of the present study were to compare the efficacy of oxytocin bolus alone, oxytocin bolus and infusion, carbetocin bolus alone, and carbetocin bolus followed by oxytocin infusion in reducing blood loss during and after cesarean section and reducing the needs for additional uterotonic agents. Methods: 200 women scheduled for elective CS under spinal anaesthesia were divided into 4 groups, group I received oxytocin 10 IU bolus followed by placebo In saline for 4 hours, group II received 10 IU oxytocin followed by 40 IU oxytocin in saline for 4 hours, group III received carbetocin 100μ g bolus and placebo in saline for 4 hours, and group IV received carbetocin 100μ g bolus followed by 40 IU oxytocin in saline for 4 hours. The main parameters evaluated were calculated blood loss during CS and 24 hours after in addition to the need for additional uterotonic drugs. Results: Blood loss was comparable and accepted clinically in the 4 study groups but loss was less during CS in both carbetocin groups. Post-operative blood loss and the needs for additional uterotonic drugs were less in the oxytocin infusion groups. Non of the included women were in need for blood transfusion. Conclusions: We concluded that carbectocin and oxytocin are comparable drugs for reducing blood loss and maintaining uterine tone during and after CS. Adding oxytocin infusion for 4 hours postoperatively may decrease blood loss and the needs for additional uterotonic agents.