Intravenous Carbetocin Versus Rectal Misoprostol for the Active Management of the Third Stage of Labor

Postpartum hemorrhage (PPH) remains the top cause of maternal death globally. Multiple uterotonic medications are available to prevent PPH; however, it is still unknown which one is the most effective. 

A study by Albazee E. et al. compared the efficacy and safety of intravenous carbetocin with rectal misoprostol for the active management of the third stage of labor to prevent PPH. It found eligible studies from digital medical sources, including the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (WOS), PubMed, Scopus, and Google Scholar, from inception until September 2022; and selected only randomized controlled trials (RCTs) that matched the inclusion requirements. 

The study screened 621 articles after omitting duplicates and eventually included three RCTs for analysis. These RCTs included 404 patients; 202 patients from the intravenous carbetocin group and 202 patients from the rectal misoprostol group. Two RCTs had a "low" risk of bias, whereas one RCT had "some concerns" regarding the quality assessment. 

Regarding efficacy endpoints, the intravenous carbetocin group showed significantly lower blood loss, need for additional uterotonics, uterine massage, and blood transfusion compared with the rectal misoprostol group. Regarding safety endpoints, the intravenous carbetocin group showed lower rates of diarrhea and chills than the rectal misoprostol group. However, both groups showed similarities regarding headache and facial flushing rates. 

This study discovered intravenous carbetocin as a superior substitute for rectal misoprostol for actively managing the third stage of labor. With very few side effects, intravenous carbetocin decreases postpartum blood loss and further uterotonic use. Intravenous carbetocin can be given to women with a high risk of PPH.

Cureus. 2022 Oct 12;14(10):e30229. doi: 10.7759/cureus.30229. PMID: 36246091; PMCID: PMC9555680.