Comparación entre carbetocina y oxitocina en la prevención de hemorragia posparto en cesáreas: revisión sistemática
DOI:
https://doi.org/10.36097/rgcs.v3i1.3198Palabras clave:
hemorragia posparto, cesárea, oxitocina, carbetocina, mortalidadResumen
La hemorragia posparto es una de las principales causas de mortalidad materna, especialmente en mujeres sometidas a cesáreas. El objetivo de este estudio fue comparar la eficacia y seguridad de la carbetocina en relación con la oxitocina para la prevención de la hemorragia postparto en mujeres que han tenido una cesárea, mediante una revisión crítica y síntesis de la evidencia disponible. Se realizo una revisión sistemática utilizando las guías prisma. Se buscaron estudios en bases de datos como PubMed, Cochrane Library, Scopus y Embase, que comparen directamente la oxitocina y carbetocina en mujeres con HPP tras una cesárea. Se evaluó la calidad metodológica de los estudios con JADAD y Rob 2 para determinar el riesgo de sesgos. Se incluyeron 7 estudios en el período 2015 al 2025, un total de 848 participantes. Los parámetros de los resultados evaluados fueron pérdida de sangre (p= 0.12), uso de uterotónicos adicionales (p< 0.001), intensidad del tono uterino (P= 1) y hemoglobina (p= 0.351). Esta revisión sistemática concluye, que no existen diferencias significativas entre ambos fármacos para la HPP post cesárea.
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Al Zubaidi, S., & Alhaidari, T. (2022). Heat stable carbetocin vs. oxytocin for the prevention of post-partum hemorrhage in emergency caesarean delivery: A randomized controlled trial. Journal of Perinatal Medicine, 50(2), 150–156. https://doi.org/10.1515/jpm-2021-0206
Albazee, E., Soliman, A., Albakri, K., Elbanna, M., Moussa, N. A., & Faragalla, H. M. (2023). Efficacy and safety of rectal misoprostol versus intravenous oxytocin on reducing blood loss in cesarean section: A PRISMA-compliant systematic review and meta-analysis of randomized clinical trials. Turkish Journal of Obstetrics and Gynecology, 20(2), 142–153. https://doi.org/10.4274/tjod.galenos.2023.15098
Anaposala, S., Kalluru, P. K. R., Calderon Martinez, E., Bhavanthi, S., & Gundoji, C. R. (2023). Postpartum Hemorrhage and Tranexamic Acid: A Literature Review. Cureus, 15(5): e38736. https://doi.org/10.7759/cureus.38736
Briones, J. C. (2025). Advancements in the management of postpartum hemorrhage: a semi-systematic review. Ginecología y Obstetricia de México, 93(4), 152–163. https://doi.org/10.24245/gom.v93i4.156
Brun, R., Meier, L., Kapfhammer, E., Zimmermann, R., Ochsenbein-Kölble, N., & Haslinger, C. (2024). Intramyometrial and intravenous oxytocin compared to intravenous carbetocin for prevention of postpartum hemorrhage in elective cesarean section—A quasi-randomized controlled phase IV non-inferiority interventional trial. Acta Obstetricia et Gynecologica Scandinavica, 103(9), 1838–1846. https://doi.org/10.1111/aogs.14893
Castiblanco, R. A., Coronado, C. M. Morales, L. V., Polo, T. V., & Saavedra, A. J. (2022). Postpartum hemorrhage: Nursing interventions and management to prevent hypovolemic shock. Revista Cuidarte, 13(1), e2075. https://doi.org/10.15649/cuidarte.2075
De Cassai, A., Boscolo, A., Zarantonello, F., Pettenuzzo, T., Sella, N., Geraldini, F., Munari, M., & Navalesi, P. (2023). Enhancing study quality assessment: an in-depth review of risk of bias tools for meta-analysis—a comprehensive guide for anesthesiologists. Journal of Anesthesia, Analgesia and Critical Care, 3, 44. BioMed Central Ltd. https://doi.org/10.1186/s44158-023-00129-z
Delgado, F. V. (2020). Usos y milagros de la Carbetocina en cesárea Uses and miracles of Carbetocine in cesárea. SCientifica, 18(1), 10-13. https://orcid.org/0000-0002-8535-1795
Delorme, P., Kayem, G., Legardeur, H., Roux-Dessarps, L. A., Girard, G., Meunier, G., Keita, H., & Mandelbrot, L. (2020). Carbetocin versus Oxytocin for the Prevention of Postpartum Hemorrhage in Cesarean Deliveries: A Retrospective Study of Two Consecutive Periods. American Journal of Perinatology Reports, 10(3), E241–E246. https://doi.org/10.1055/s-0040-1715163
El-Goly, N. A., Maged, A. M., Kamal, W. M., Hosny, O., Turki, D., & Helmy, N. M. (2025). Carbetocin versus oxytocin in prevention of postpartum hemorrhage after cesarean delivery in high-risk women. A systematic review and meta-analysis. Archives of Gynecology and Obstetrics, 312, 291–309. https://doi.org/10.1007/s00404-025-08014-6
Fahmy, N. G., Yousef, H. M., & Zaki, H. V. (2016). Comparative study between effect of carbetocin and oxytocin on isoflurane-induced uterine hypotonia in twin pregnancy patients undergoing cesarean section. Egyptian Journal of Anaesthesia, 32(1), 117–121. https://doi.org/10.1016/j.egja.2015.09.012
Gallos, I. D., Yunas, I., Devall, A. J., Podesek, M., Tobias, A., Price, M. J., Oladapo, O. T., & Coomarasamy, A. (2025). Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. Cochrane Database of Systematic Reviews, (4). https://doi.org/10.1002/14651858.CD011689.pub4
Gök, S., & Kaleli, M. B. (2023). Investigation of The Effects of Oxytocin Administration Timing on Postpartum Hemorrhage during Cesarean Section. Medicina (Lithuania), 59(2), 222. https://doi.org/10.3390/medicina59020222
Guillén-Terán, A. M., & Viracocha-Toapanta, E. (2025). Factores de riesgos asociados a las hemorragias post parto durante el puerperio inmediato en el Ecuador. MQRInvestigar, 9(1), e345. https://doi.org/10.56048/MQR20225.9.1.2025.e345
Gupta, A. K. (2023). Carbetocin: Are We Ready for a Paradigm Shift? Journal of Obstetric Anaesthesia and Critical Care, 13(2), 127–129. https://doi.org/10.4103/JOACC.JOACC_55_23
Ibrahim, Z. M., Sayed Ahmed, W. A., Abd El-Hamid, E. M., Taha, O. T., & Elbahie, A. M. (2020). Carbetocin versus oxytocin for prevention of postpartum hemorrhage in hypertensive women undergoing elective cesarean section. Hypertension in Pregnancy, 39(3), 319–325. https://doi.org/10.1080/10641955.2020.1768268
Jin, X. H., Li, D., & Li, X. (2019). Carbetocin vs oxytocin for prevention of postpartum hemorrhage after vaginal delivery: A meta-analysis. Medicine (Baltimore), 98(47), e17911. https://doi.org/10.1097/MD.0000000000017911
Kalafat, E., Gokce, A., O’Brien, P., Benlioglu, C., Koc, A., Karaaslan, O., & Khalil, A. (2021). Efficacy of carbetocin in the prevention of postpartum hemorrhage: a systematic review and Bayesian meta-analysis of randomized trials. Journal of Maternal-Fetal and Neonatal Medicine, 34(14), 2303–2316. https://doi.org/10.1080/14767058.2019.1664463
Li, M. X., Liu, C. R., Chen, M., Shang, H. C., Wang, W., Luo, X. C., Li, L., Qi, Y. N., Xiong, Y. Q., Huang, S. Y., Wang, J., Zou, K., Liu, X. H., Tan, J., & Sun, X. (2022). Effects of Motherwort Injection Versus Intramuscular Oxytocin for Preventing Postpartum Hemorrhage Among Women Who Underwent Cesarean Section. Frontiers in Pharmacology, 13. https://doi.org/10.3389/fphar.2022.859495
Maged, A. M., El-Goly, N. A., Turki, D., Bassiouny, N., & El-Demiry, N. (2025). A systematic review and meta-analysis of randomized trials comparing carbetocin to oxytocin in prevention of postpartum hemorrhage after cesarean delivery in low-risk women. Journal of Obstetrics and Gynaecology Research, 51(1). https://doi.org/10.1111/jog.16194
Mannaerts, D., Van Der Veeken, L., Coppejans, H., & Jacquemyn, Y. (2018). Adverse Effects of Carbetocin versus Oxytocin in the Prevention of Postpartum Haemorrhage after Caesarean Section: A Randomized Controlled Trial. Journal of Pregnancy, 2018. https://doi.org/10.1155/2018/1374150
McDonagh, F., Carvalho, J. C. A., Abdulla, S., Cordovani, D., Downey, K., Ye, X. Y., Farine, D., Morais, M., & Balki, M. (2022). Carbetocin vs. oxytocin at elective caesarean delivery: a double-blind, randomised, controlled, non-inferiority trial of low- and high-dose regimens. Anaesthesia, 77(8), 892–900. https://doi.org/10.1111/anae.15714
Ministerio de Salud Pública [MSP]. (2025). Subsecretaría de Vigilancia, Prevención y Control de la Salud, Dirección Nacional de Vigilancia Epidemiológica. (2025). Gaceta epidemiológica de muerte materna SE 17 Ecuador 2025. Ministerio de Salud Pública del Ecuador. https://www.salud.gob.ec/wp-content/uploads/2025/05/Gaceta-MM-SE-17-2025.pdf
Nucamendi, E. N., Chávez, J. M., Long, N. J., Hernández, L. E., & López, S. A. (2024). Prevención de hemorragia posparto durante la cesárea mediante ligadura de las arterias uterinas en pacientes con factores de riesgo. Ginecología y Obstetricia de México, 92(2), 52–59. https://doi.org/10.24245/gom.v92i2.9405
Ortuanya, K. E., Eleje, G. U., Ezugwu, F. O., Odugu, B. U., Ikechebelu, J. I., Ugwu, E. O., Eke, A. C., Awkadigwe, F. I., Ezenwaeze, M. N., Ofor, I. J., Okafor, C. C., & Okafor, C. G. (2024). Prophylactic tranexamic acid for reducing intraoperative blood loss during cesarean section in women at high risk of postpartum hemorrhage: A double-blind placebo randomized controlled trial. Women’s Health, 20. https://doi.org/10.1177/17455057231225311
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L. A., Stewart, L. A., Thomas, J., Tricco, A. C., Welch, V. A., Whiting, P., & Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372(71). https://doi.org/10.1136/bmj.n71
Patil, A., Puram, M., & Thobbi, V. A. (2024). Carbetocin versus oxytocin in primigravida for active management of third stage of labor: a prospective study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 13(3), 589–593. https://doi.org/10.18203/2320-1770.ijrcog20240460
Sterne, J. A. C., Savović, J., Page, M. J., Elbers, R. G., Blencowe, N. S., Boutron, I., Cates, C. J., Cheng, H. Y., Corbett, M. S., Eldridge, S. M., Emberson, J. R., Hernán, M. A., Hopewell, S., Hróbjartsson, A., Junqueira, D. R., Jüni, P., Kirkham, J. J., Lasserson, T., Li, T., McAleenan, A., Reeves, B. C., Shepperd, S., Shrier, I., Stewart, L. A., Tilling, K., White, I. R., Whiting, P. F., & Higgins, J. P. T. (2019). RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ, 366. https://doi.org/10.1136/bmj.l4898
Tixe, E. A., Chalan, M. C., Panimboza, I. P., Sanaguano, J. M., Escobar, P. R., Dután, F. G., Serpa, P. E., & Quispe, M. E. (2023). Evidencia de la carbetocina en la hemorragia obstétrica. Salud, Ciencia y Tecnología, 3, 341. Salud, Ciencia y Tecnología. https://doi.org/10.56294/saludcyt2023341
Trivedi, K., Sinha, T., Boipai, P., Kumari, P., Sharma, A., Singh, A., & Kumari, S. (2025). The Role of Oxytocin versus Carbetocin in Prevention of Postpartum Hemorrhage in Cesarean Section: A Randomized Control Trial. Annals of African Medicine, 24(2), 378–383. https://doi.org/10.4103/aam.aam_218_24
Turner, W., Boonstra, L., Maxwell, C., Downey, K., & Balki, M. (2025). Oxytocin versus carbetocin at elective Cesarean delivery in parturients with class III obesity: a double-blind randomized controlled noninferiority trial. Canadian Journal of Anesthesia, 72(3), 426–435. https://doi.org/10.1007/s12630-024-02891-2
Whitley, J., Burd, J., Doering, M., Kelly, J., Frolova, A., & Raghuraman, N. (2025). Reduced risk of cesarean delivery with oxytocin discontinuation in active labor: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 233(1), 25-39.e11. https://doi.org/10.1016/j.ajog.2025.03.015
Yesmin, S., Begum, F., Bain, S., Imrul, AH., Farhana, I., & Hafiza, F. (2020). Carbetocin versus Oxytocin in the Prevention of Postpartum Haemorrhage after Caesarean Section. Bangladesh Journal of Obstetrics & Gynaecology, 35(2), 63–67. https://doi.org/10.3329/bjog.v35i2.58786
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Derechos de autor 2026 Erick S. Rojas, Carla S. Defaz, Karla A. Mayorga, Rodrigo D. Jiménez, Luis A. Guano
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