Effectiveness of Carbetocin in Caesarean section for prevention of Post-partum haemorrhage(PPH) in comparison with Oxytocin at a tertiary Institute: A randomised controlled study

Obstetric haemorrhage, especially postpartum haemorrhage (PPH) is responsible for more than a quarter of all maternal deaths worldwide. In most low-income countries, PPH is the leading cause of maternal deaths. Postpartum haemorrhage occurs in 5-15% of deliveries. The majority of PPH related morbidity and mortality are preventable through effective implementation of  evidenced-based guidelines. Uterine atony is responsible for more than 50% of occurrences of PPH, numerous strategies have been promoted to preserve uterine tone.There are several uterotonic drugs for preventing PPH but it is still debatable which drug is best. Oxytocin (10 IU) is administered for the prevention of PPH in low risk vaginal and caesarean deliveries. Carbetocin is a long-acting synthetic oxytocin analogue, 1-deamino-1- monocarbo-(2-O-Methyltyrosine)-oxytocin, firstly described in 1987. Carbetocin, given as 100 microgram as an IV bolus over 1 minute, instead of continuous infusion of oxytocin with a a similar safety profile and minor antidiuretic effect, in the third stage of labour and in the first 24 hours. Crabetocin is approved by WHO (2018) and included in the WHO (2019) essential medicines drug list. Storage and cold chain maintenance of Oxytocin is difficult unlike heat stable carbetocin in Manipur. Recently it has been approved by drug controller of India for use in prevention of  PPH and is now available in India. In Manipur, carbetocin has not been used and no such study in pregnant women for PPH prevention.