Effect of Carbetocin on Postpartum Hemorrhage after Vaginal Delivery: A Meta-Analysis

Abstract

Background. The efficacy of oxytocin and carbetocin in preventing postpartum hemorrhage (PPH) in women with vaginal delivery has been controversial. This study is aimed at conducting a meta-analysis that compares the efficacy of carbetocin and oxytocin in the prevention of PPH among women with vaginal delivery. Methods. Literature was retrieved from PubMed, Medline, Embase, CENTRAL, and CNKI databases. The randomized controlled trials (RCTs) that compare the efficacy of carbetocin and oxytocin to prevent PPH were searched. Data from the included literatures were extracted by two researchers, including author, title, publication date, study type, study number, the incidence of PPH, number of patients requiring additional uterotonics, and number of patients requiring blood transfusion. Jadad scale was used to evaluate the quality of the included RCTs. The Chi-square test was adopted for the heterogeneity test. A fixed-effect model was used for analysis if heterogeneity did not exist between literatures. If heterogeneity exists between literatures, a random-effect model was used for analysis. The source of heterogeneity was explored by subgroup analysis and sensitivity analysis. Results. The incidence of PPH in the carbetocin group was lower than that in the oxytocin group ( $\text{OR}=0.62$ , 95% CI (0.46, 0.84), $Z=3.14$ , $P=0.002$ ). There was no heterogeneity among studies ( ${\chi }^2=7.29$ , $P=0.12$ , $I^2=45\%$ ) and no significant publication bias ( $P>0.05$ ). The proportion of women requiring additional uterotonics in the carbetocin group was lower than that in the oxytocin group ( $\text{OR}=0.41$ , 95% CI (0.29, 0.56), $Z=5.34$ , $P<0.00001$ ). There was no heterogeneity among studies ( ${\chi }^2=0.82$ , $P=0.84$ , $I^2=0\%$ ) and no significant publication bias ( $P>0.05$ ). There was no significant difference in the proportion of women needing blood transfusion between the carbetocin group and the oxytocin group ( $\text{OR}=0.92$ , 95% CI (0.66, 1.29), $Z=0.46$ , $P=0.64$ ). There was no heterogeneity among studies ( ${\chi }^2=3.06$ , $P=0.55$ , $I^2=0\%$ ) and no significant publication bias ( $P>0.05$ ). Conclusion. Carbetocin is superior to oxytocin in preventing PPH among women with vaginal delivery and can be widely used in clinical practice.