A Multi-Center Randomized Trial of Carbetocin versus Oxytocin for the Prevention of Postpartum Hemorrhage after Vaginal Delivery

International Journal of Obstetrics and Gynecology | Vol. 14, No. 6, June 2026 | pp. 49–60

DOI: 10.46882/2026/IJOG/000481

Original Research Article

Title: A Multi-Center Randomized Trial of Carbetocin versus Oxytocin for the Prevention of Postpartum Hemorrhage after Vaginal Delivery

Names of Authors: Emeka J. Obi¹, Funmilayo R. Adeyemi², Zainab H. Dogara¹

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
² Maternal Health Division, Federal Ministry of Health, Abuja, Nigeria

Abstract:
Postpartum Hemorrhage (PPH) remains a primary contributor to avoidable maternal death. While oxytocin is widely utilized for routine prophylaxis, its short half-life necessitates continuous intravenous infusion. This multi-center, double-blind, randomized controlled trial investigated whether a single intramuscular injection of carbetocin, a long-acting oxytocin agonist, provides superior efficacy over standard oxytocin infusion for preventing PPH following singleton vaginal deliveries. A cohort of 1,800 low-risk pregnant women at term was randomized to receive either a single 100 μg intramuscular dose of carbetocin (n = 900) or a standard 10 IU intravenous oxytocin infusion administered over 4 hours (n = 900) immediately following fetal expulsion. The primary endpoint measured was the incidence of blood loss ≥ 500 mL or the requirement for additional uterotonic intervention. The incidence of PPH ≥ 500 mL was 3.8% in the carbetocin group compared to 6.2% in the oxytocin group, representing a statistically significant risk reduction (Relative Risk [RR] = 0.61; 95% CI, 0.40 to 0.93; p = 0.021). The utilization of additional therapeutic uterotonics was lower in the carbetocin cohort (2.4% vs. 5.1%, p = 0.003). Severe PPH (blood loss ≥ 1,000 mL) occurred in 0.7% of carbetocin patients versus 1.4% of oxytocin patients (p = 0.14). The safety profiles, including rates of transient nausea, headache, flushing, and maternal tachycardia, were comparable between the groups (p > 0.05). A single intramuscular injection of carbetocin offers superior clinical efficacy in reducing the incidence of postpartum hemorrhage and minimizing secondary therapeutic uterotonic interventions following vaginal delivery.

Keywords: Postpartum Hemorrhage; Carbetocin; Oxytocin; Vaginal Delivery; Uterotonics; Maternal Mortality.

Manuscript Timeline: Received: February 20, 2026; Revised: April 14, 2026; Accepted: May 10, 2026; Published: June 15, 2026.

Citation: Obi EJ, Adeyemi FR, Dogara ZH. A Multi-Center Randomized Trial of Carbetocin versus Oxytocin for the Prevention of Postpartum Hemorrhage after Vaginal Delivery. International Journal of Obstetrics and Gynecology. 2026; 14(6): 49–60.

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