Clinical Efficacy of Carbetocin as Primary Uterotonic in High-Risk Cesarean Deliveries: A Retrospective Case Series from a Brazilian Public Tertiary Center

Author(s) 

 

Authors:

Francinni Mambrini Pires Rego, MD* | Mariana Rego de Carvalho, MD | Erika Jordao, MD | Gabriela Tognini Saba, MD | Fernando de Souza Nani, MD

 

SLIDE 1: Background & Hypothesis

The Clinical Problem

• Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality

• Uterotonic selection is critical in high-risk cesarean deliveries

• Resource-limited public systems face logistical constraints with continuous infusions

 

Why Carbetocin?

• Long-acting oxytocin analogue with ~40-minute half-life

• Single IV bolus eliminates need for infusion pumps

• Reduces nursing workload and improves medication safety

• Efficacy established in developed-country cohorts

 

The Evidence Gap

• Limited data from public health systems managing high-risk populations

• Unknown performance in resource-constrained tertiary centers

• Need for real-world effectiveness data in Brazilian context

 

Study Aim

Evaluate the clinical efficacy and safety of carbetocin as primary uterotonic in high-risk cesarean deliveries at a Brazilian public tertiary center.

 

SLIDE 2: Study Design and Methods

Study Design & Setting

• Retrospective consecutive case series

• Public hospital, Brazilian Unified Health System (SUS)

• Tertiary care center serving high-risk obstetric population

• Study Period: December 16–23, 2025 | Sample: n = 22 cesarean deliveries

 

Anesthesia Profile

• Spinal anesthesia: 77.3% (n = 17)

• Combined spinal-epidural: 22.7% (n = 5)

 

Intervention

• Protocol: 100 mcg carbetocin IV bolus after umbilical cord clamping

• Single-dose regimen; no infusion required

 

Outcomes

• Primary: Therapeutic failure (need for additional uterotonic)

• Secondary: Quantitative blood loss (gravimetric method), hemodynamics, transfusion requirement, adverse effects

 

Study Flow:

Consecutive Cesarean Deliveries (Dec 16–23, 2025) → n = 22 enrolled → Carbetocin 100 mcg IV bolus (post-cord clamp) → Outcomes: Efficacy, QBL, Transfusion, Adverse Effects

 

 

SLIDE 3: Results

Sample Characteristics

• Mean age: 30.6 ± 5.8 years | BMI: 28.3 ± 11.7 kg/m²

• Gestational age: 36.7 ± 3.4 weeks

• Comorbidities present in 90.9% (20/22)

• 54.5% (12/22) with ≥1 risk factor

 

PRIMARY OUTCOME: Efficacy

• Carbetocin Monotherapy Successful: 86.4% (19/22; 95% CI 72.0–100.7%)

• Therapeutic Failure: 13.6% (3/22)

 

•Case 1: Twins → methylergometrine added | QBL 930 mL

•Case 2: HTN, diabetes, endometriosis, IVF → methylergometrine + misoprostol | QBL 1064 mL

•Case 3: Thrombocytopenia (77K), anemia → methylergometrine + tranexamic acid | QBL 506 mL

 

Quantitative Blood Loss (QBL)

• QBL ≥1000 mL: 9.1% (2/22)

• QBL in failures: 833 ± 291 mL vs. successes: 467 ± 238 mL

 

Transfusion & Adverse Effects

• Transfusions: 0%

• Adverse effects: 0% (no nausea, vomiting, flushing, headache, or chest pain)

 

Notable Case

• Focal placenta accreta managed with carbetocin monotherapy

 

 

SLIDE 4: Conclusion and Discussion

Key Findings

• Carbetocin achieved 86.4% efficacy as sole uterotonic in high-risk cesarean deliveries

• Zero transfusions and zero adverse effects in this consecutive case series

• Single-dose regimen eliminates infusion pumps and reduces nursing workload

 

Clinical Implications

• Carbetocin offers a practical first-line option in resource-limited public settings

• Logistical advantages: simplified medication administration, reduced equipment dependency

• Efficacy comparable to published data from developed-country cohorts

• Immediate availability of second-line agents (methylergometrine, misoprostol) remains essential

 

Predictors of Failure (Observed Trends)

• Uterine overdistension (twins)

• Multiple comorbidities (hypertension, diabetes, endometriosis)

• Hematologic compromise (thrombocytopenia, anemia)

 

Study Limitations

• Small sample size (n = 22) and one-week timeframe

• Retrospective design; selection bias mitigated by consecutive case capture

• Findings hypothesis-generating; larger prospective studies needed

 

Conclusion

In this consecutive case series, carbetocin demonstrated favorable efficacy and safety as primary uterotonic in high-risk cesarean deliveries at a Brazilian public tertiary center. The single-dose regimen offers meaningful logistical advantages in resource-constrained settings. However, 13.6% of cases required rescue therapy, particularly in uterine overdistension or multiple comorbidities. These findings support carbetocin as a first-line uterotonic in government-funded high-risk cesarean deliveries, provided immediate second-line agents are available. Larger prospective studies are needed to identify predictors of failure and optimize patient selection.

 

REFERENCES:

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