Prophylactic Carbetocin Versus Oxytocin and Blood Loss After Vaginal Delivery: Agent Selection and Confounding by Indication in a Retrospective Cohort Study.
- 1Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien 970, Taiwan.
- 2Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan.
Abstract
Background and Objectives: Carbetocin is increasingly used for postpartum hemorrhage (PPH) prophylaxis, but its selection in routine practice may bias comparisons with oxytocin. This observational study examined the association between the agent received and blood loss after vaginal delivery. Materials and Methods: This retrospective cohort included 559 women delivering vaginally in 2022-2023 who received carbetocin 100 μg intravenously (n = 474) or oxytocin 10 IU by infusion (n = 85). Gravimetric blood loss was analyzed using linear (primary), robust and median (co-primary) regression, and propensity score methods. Results: Carbetocin recipients more often underwent induction (63.3% vs. 43.5%), vacuum extraction (26.8% vs. 15.3%), and epidural analgesia (76.2% vs. 29.4%). Blood loss was higher with carbetocin before adjustment (223.7 vs. 180.0 mL, p = 0.003) but not after adjustment (β 12.72 mL, 95% CI -50.19 to 75.64, p = 0.691; robust p = 0.479; median p = 0.354). Propensity score results conflicted: inverse probability weighting showed higher blood loss with carbetocin (47.84 mL, p = 0.002), whereas matching and trimmed weighting did not. PPH occurred in 2.7% vs. 0% (p = 0.234). Conclusions: Carbetocin was preferentially used in higher-risk labors, indicating confounding by indication. Adjusted blood loss did not differ significantly, although a modest increase could not be excluded. The study was severely underpowered for PPH.
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BibTeX
@article{tsui2026prophylactic,
title = {{Prophylactic Carbetocin Versus Oxytocin and Blood Loss After Vaginal Delivery: Agent Selection and Confounding by Indication in a Retrospective Cohort Study.}},
author = {Wing Lam Tsui and Dah-Ching Ding},
journal = {Medicina (Kaunas, Lithuania)},
year = {2026},
month = oct,
doi = {10.3390/medicina62101967},
url = {https://europepmc.org/article/MED/42942498},
note = {CC BY},
}
RIS
TY - JOUR
TI - Prophylactic Carbetocin Versus Oxytocin and Blood Loss After Vaginal Delivery: Agent Selection and Confounding by Indication in a Retrospective Cohort Study.
AU - Wing Lam Tsui
AU - Dah-Ching Ding
PY - 2026
DA - 2026/10/12
JO - Medicina (Kaunas, Lithuania)
DO - 10.3390/medicina62101967
UR - https://europepmc.org/article/MED/42942498
AB - Background and Objectives: Carbetocin is increasingly used for postpartum hemorrhage (PPH) prophylaxis, but its selection in routine practice may bias comparisons with oxytocin. This observational study examined the association between the agent received and blood loss after vaginal delivery. Materials and Methods: This retrospective cohort included 559 women delivering vaginally in 2022-2023 who received carbetocin 100 μg intravenously (n = 474) or oxytocin 10 IU by infusion (n = 85). Gravimetric blood loss was analyzed using linear (primary), robust and median (co-primary) regression, and propensity score methods. Results: Carbetocin recipients more often underwent induction (63.3% vs. 43.5%), vacuum extraction (26.8% vs. 15.3%), and epidural analgesia (76.2% vs. 29.4%). Blood loss was higher with carbetocin before adjustment (223.7 vs. 180.0 mL, p = 0.003) but not after adjustment (β 12.72 mL, 95% CI -50.19 to 75.64, p = 0.691; robust p = 0.479; median p = 0.354). Propensity score results conflicted: inverse probability weighting showed higher blood loss with carbetocin (47.84 mL, p = 0.002), whereas matching and trimmed weighting did not. PPH occurred in 2.7% vs. 0% (p = 0.234). Conclusions: Carbetocin was preferentially used in higher-risk labors, indicating confounding by indication. Adjusted blood loss did not differ significantly, although a modest increase could not be excluded. The study was severely underpowered for PPH.
SN - 1010-660X
SN - 1648-9144
ER -