Efficacy of carbetocin for preventing postpartum bleeding after cesarean section in twin pregnancy.

Objective: This is a prospective observational study whose goal was to compare the effectiveness of carbetocin and oxytocin for prevention of postpartum hemorrhage (PPH) when they are administered in twin pregnancies undergoing a cesarean section. Design: We enrolled 166 twin pregnancies at term undergoing elective or emergency cesarean section. We compared the effect of a single 100 µg dose of carbetocin with the use of oxytocin as a protocol (20 IU in Ringer lactate 500 ml in 10-15 min). The main variables studied were intraoperative bleeding, surgical time, hemoglobin fall, hematocrit drop, additional uterotonic use (Methylergometrine and/or misoprostol), need for blood transfusion, and/or IV iron therapy. Results: In the oxytocin group there was a greater fall in the hemoglobin level (1.7 versus 1.2, p  = .02). Along the same line, the control group presented a significantly greater need for blood transfusion (9.3 versus 1.3%, =0.03), as well as treatment for anemia as a composite variable (intravenous (IV) iron therapy and/or blood transfusion) 16.3 versus 3.85% for each group [OR 0.2 (0.05-0.72)]. In addition, the use of carbetocin was associated with a reduction in the need to administer additional treatments (uterotonic and/or treatment for anemia) during the postpartum period compared with the use of oxytocin O.R 0.32 (0.12-0.88). Conclusions: In our population of twin pregnancies delivered by cesarean section, carbetocin appears more effective than oxytocin in preventing PPH.