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Administration of a uterotonic such as oxytocin helps prevent postpartum hemorrhage after vaginal delivery; however, oxytocin requires cold storage. Is carbetocin (a heat-stable, long-acting oxytocin formulation) as effective? Furthermore, can oxytocin's prophylactic efficacy be improved with dual therapy that adds tranexamic acid (an antifibrinolytic)?
In an international trial to compare the effectiveness of carbetocin and oxytocin, some 30,000 women in labor with imminent vaginal delivery were randomized to receive a single intramuscular dose of carbetocin (100 µg) or oxytocin (10 IU). The two agents did not differ regarding incidence of blood loss ≥500 mL (14.5% [carbetocin] and 14.4% [oxytocin]) or blood loss ≥1000 mL (1.5% and 1.4%).
In…