Comparative study of hemodynamic effects of carbetocin and oxytocin in patient undergoing elective lower segment caesarean section under spinal anaesthesia: An observational analytical study

Background and Aims: Postpartum haemorrhage (PPH) is a leading cause of maternal mortality, primarily due to uterine atony. Prophylactic uterotonics are a cornerstone of PPH prevention. While oxytocin is the first-line agent, it is frequently associated with significant hemodynamic instability. Carbetocin, a long-acting synthetic oxytocin analogue, may offer comparable efficacy with improved hemodynamic stability. This study compared the hemodynamic effects, uterotonic efficacy, need for additional uterotonics, blood loss, and side effect profiles of carbetocin versus oxytocin in patients undergoing elective caesarean section under spinal anaesthesia.Materials and Methods: In this observational analytical study, 70 patients scheduled for elective caesarean section under spinal anaesthesia were randomly allocated into two groups (n=35 each). One group received a single intravenous dose of carbetocin, while the other received oxytocin. Hemodynamic parameters, including systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR), were recorded at regular intervals. The need for additional uterotonics, estimated postoperative blood loss, and incidence of adverse effects were assessed.Results: The carbetocin group exhibited significantly greater hemodynamic stability, with a lower incidence of hypotension compared to the oxytocin group, most notably at the 10-minute mark (p=0.031). Uterotonic efficacy, as assessed by initial uterine contraction, was comparable between groups. However, the requirement for additional uterotonic agents was significantly lower in the carbetocin group (5.7%) than in the oxytocin group (31.4%). Postoperative blood loss and the overall profile of side effects were similar between the two groups.Conclusions: Carbetocin provides superior hemodynamic stability compared to oxytocin, with equivalent uterotonic efficacy and a comparable safety profile. The significantly reduced need for rescue uterotonics further supports carbetocin as a preferable prophylactic agent in patients undergoing caesarean section under spinal anaesthesia.