Efficacy of Carbetocin versus Conventional Uterotonic Regimens in Reducing Postpartum Blood Loss: A Comparative Study in Low-Risk Vaginal and Cesarean Deliveries

Background Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide, primarily driven by uterine atony. While oxytocin remains the standard prophylaxis, carbetocin, a long-acting oxytocin analogue, has emerged as a potential alternative. This study compares the clinical efficacy of carbetocin versus conventional multi-drug uterotonic regimens in preventing blood loss during vaginal and Cesarean deliveries in a Taiwanese clinical setting. Methods We conducted a retrospective observational study of 128 patients delivered by a single obstetrician. Patients undergoing vaginal delivery received either carbetocin (100 µg) or a triple-drug combination (oxytocin, misoprostol, and methylergonovine). For Cesarean sections, carbetocin was compared with oxytocin alone. High-risk pregnancies were excluded to focus on low-risk populations. Statistical analysis was performed using the Mann-Whitney U test and Fisher’s exact test. Results In vaginal deliveries, carbetocin significantly reduced both primary and total blood loss compared to the triple-drug regimen (100 mL vs. 150 mL, P  < 0.001; 155 mL vs. 200 mL, P  = 0.047). In Cesarean sections, although visual blood loss estimation showed no significant difference, the carbetocin group demonstrated a significantly lower hemoglobin drop compared to cases managed by other physicians using conventional agents ( -6.3% vs. -11.93%, P  = 0.049). Conclusion Carbetocin as a single-agent prophylaxis is more effective than traditional multi-drug combinations in reducing blood loss during vaginal delivery. Furthermore, carbetocin provides superior hemodynamic stability in low-risk parturients and may effectively mitigate inter-operator variability. Trial registration: Retrospectively registered