The Effect of Carbetocin versus Misoprostol versus Ergometrine for Controlling Bleeding after Cesarean Section in Primigravidae

Background: Women undergoing cesarean section have a high risk of blood loss and so are more likely to need a blood transfusion. The aim of this work was to compare the effectiveness of using carbetocin versus misoprostol versus ergometrine for controlling bleeding after cesarean section in primigravidae.

Methods: This prospective randomized clinical trial was conducted on 150 patients aged from18-35 years old, primigravidae with singleton pregnancy undergoing elective cesarean section. Participants were divided into three equal groups: carbetocin group (group C) received a single 1-ml ampoule of carbetocin (100 μg/mL) added to 10 cm saline intravenously following the delivery of the neonate, misoprostol group (group M) received misoprostol 400ug per rectum immediately after induction of anesthesia in operating theater and ergometrine group (group E) received 0.2 mg of ergometrine intramuscularly in the first minute after delivery of the baby.

Results: The amount of blood in suction jar, amount of blood loss, Hb change and HTC change were significantly higher in the misoprostol group and ergometrine group than in the carbetocin group (p <0.05) and in the ergometrine group than the misoprostol group (p <0.001). Post-operative Hb in the ergometrine group was significantly lower in the carbetocin group (p =0.001).

Conclusions: Carbetocin can be considered a superior choice to misoprostol and ergometrine in reducing blood loss during CS in primigravidae.