{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:21:37Z","timestamp":1787772097181,"version":"build-2784847793"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality. Although 100 \u03bcg intravenous carbetocin is commonly administered for uterotonic prophylaxis at caesarean delivery, the optimal dose remains uncertain. The primary objective was to evaluate the dose\u2013response relationship of intravenous carbetocin in achieving adequate uterine tone during elective caesarean delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      In this randomised, parallel-group, dose\u2013response trial, 100 parturients scheduled for elective caesarean delivery were assigned into five groups to receive intravenous carbetocin at doses of 100 \u03bcg, 80 \u03bcg, 60 \u03bcg, 40 \u03bcg, or 20 \u03bcg (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 20 per group) immediately after foetal delivery. The primary outcome was satisfactory uterine tone at 2, 5, and 10 minutes. Secondary outcomes included blood loss, requirement for additional uterotonics, PPH incidence, blood transfusion, haemodynamic variables, and adverse events. Trend analysis assessed dose\u2013response relationships.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Baseline demographic and obstetric characteristics were comparable among groups. Uterine contraction increased progressively from 75% to 85% at 2 minutes to 90\u201395% at 5 minutes and 95\u2013100% at 10 minutes, with no significant intergroup differences (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.960, 0.921, and 0.724, respectively). Mean blood loss and requirement for additional uterotonics were similar across groups. The incidence of PPH, need for blood transfusion, haemodynamic variables, and adverse events were comparable. No significant dose\u2013response relationship was observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In low-risk, non-obese women undergoing elective caesarean delivery under spinal anaesthesia, intravenous carbetocin doses ranging from 20 \u03bcg to 100 \u03bcg resulted in similar uterotonic response and blood-loss outcomes, with no statistically significant differences between the different dose groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ija.ija_391_26","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T12:03:57Z","timestamp":1781697837000},"page":"749-756","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Dose\u2013response evaluation of intravenous carbetocin for prevention of postpartum haemorrhage during elective caesarean delivery: A parallel-group randomised controlled trial"],"prefix":"10.4103","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1693-1367","authenticated-orcid":false,"given":"Riya","family":"Abraham","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Aarupadai Veedu Medical College, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4156-6532","authenticated-orcid":false,"given":"Rajesh Prabu","family":"Chandrasekaran","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Aarupadai Veedu Medical College, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5643-0868","authenticated-orcid":false,"given":"Pradeesh","family":"Johny","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Aarupadai Veedu Medical College, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6596-0540","authenticated-orcid":false,"given":"Akshaya","family":"Manimaran","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Aarupadai Veedu Medical College, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6333-8669","authenticated-orcid":false,"given":"C L","family":"Sabu Kumar","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Aarupadai Veedu Medical College, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3741-1781","authenticated-orcid":false,"given":"Ezhilrajan","family":"Vaithiyalingam","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Aarupadai Veedu Medical College, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"R1-20260617","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/1471-0528.12636","article-title":"Postpartum haemorrhage management, risks, and maternal outcomes: Findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health","volume":"121","author":"Sheldon","year":"2014","journal-title":"BJOG"},{"key":"R2-20260617","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1056\/NEJMoa1805489","article-title":"Heat-stable carbetocin versus oxytocin to prevent hemorrhage after vaginal birth","volume":"379","author":"Widmer","year":"2018","journal-title":"N Engl J Med"},{"key":"R3-20260617","first-page":"CD007412","article-title":"Active versus expectant management for women in the third stage of labour","volume":"11","author":"Begley","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"R5-20260617","doi-asserted-by":"crossref","first-page":"e0236060","DOI":"10.1371\/journal.pone.0236060","article-title":"Quality of medicines for life-threatening pregnancy complications in low- and middle-income countries: A systematic review","volume":"15","author":"Torloni","year":"2020","journal-title":"PLoS One"},{"issue":"Suppl 1","key":"R7-20260617","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/ijgo.14116","article-title":"FIGO recommendations on the management of postpartum hemorrhage 2022","volume":"157","author":"Escobar","year":"2022","journal-title":"Int J Gynaecol Obstet"},{"key":"R8-20260617","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1111\/anae.14944","article-title":"Carbetocin at elective caesarean section: A sequential trial to determine the minimum effective dose in obese women","volume":"75","author":"Drew","year":"2020","journal-title":"Anaesthesia"},{"key":"R9-20260617","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1007\/s12630-013-0028-2","article-title":"Carbetocin at elective Cesarean delivery: A randomized controlled trial to determine the effective dose, part 2","volume":"60","author":"Anandakrishnan","year":"2013","journal-title":"Can J Anaesth"},{"key":"R10-20260617","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1007\/s12630-013-0082-9","article-title":"Carbetocin at elective Cesarean delivery: A sequential allocation trial to determine the minimum effective dose","volume":"61","author":"Khan","year":"2014","journal-title":"Can J Anaesth"},{"key":"R11-20260617","doi-asserted-by":"crossref","first-page":"e17911","DOI":"10.1097\/MD.0000000000017911","article-title":"Carbetocin vs oxytocin for prevention of postpartum hemorrhage after vaginal delivery: A meta-analysis","volume":"98","author":"Jin","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"R12-20260617","first-page":"CD005457","article-title":"Oxytocin agonists for preventing postpartum haemorrhage","volume":"3","author":"Su","year":"2007","journal-title":"Cochrane Database Syst Rev"},{"key":"R13-20260617","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.ajog.2021.08.060","article-title":"Preventing postpartum hemorrhage after cesarean delivery: A network meta-analysis of available pharmacologic agents","volume":"226","author":"Jaffer","year":"2022","journal-title":"Am J Obstet Gynecol"},{"key":"R14-20260617","doi-asserted-by":"crossref","first-page":"2303","DOI":"10.1080\/14767058.2019.1664463","article-title":"Efficacy of carbetocin in the prevention of postpartum hemorrhage: A systematic review and Bayesian meta-analysis of randomized trials","volume":"34","author":"Kalafat","year":"2021","journal-title":"J Matern Fetal Neonatal Med"},{"key":"R15-20260617","first-page":"28","article-title":"Carbetocin is a functional selective gq agonist that does not promote oxytocin receptor recycling after inducing ?-arrestin-independent internalisation","author":"Passoni","year":"2016","journal-title":"J Neuroendocrinol"},{"key":"R16-20260617","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.ijoa.2019.06.007","article-title":"Carbetocin reduces the need for additional uterotonics in elective caesarean delivery: A systematic review, meta-analysis and trial sequential analysis of randomised controlled trials","volume":"40","author":"Onwochei","year":"2019","journal-title":"Int J Obstet Anesth"},{"key":"R17-20260617","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/s41669-018-0108-x","article-title":"Uterotonic drugs for the prevention of postpartum haemorrhage: A cost-effectiveness analysis","volume":"3","author":"Pickering","year":"2019","journal-title":"Pharmacoecon Open"},{"key":"R19-20260617","doi-asserted-by":"crossref","first-page":"2046","DOI":"10.1111\/jog.16097","article-title":"A randomized controlled trial on the comparison of two doses of carbetocin with oxytocin for the prevention of postpartum hemorrhage (concert trial)","volume":"50","author":"Balogun","year":"2024","journal-title":"J Obstet Gynaecol Res"},{"key":"R20-20260617","first-page":"CD011689","article-title":"Uterotonic agents for preventing postpartum haemorrhage: A network meta-analysis","volume":"12","author":"Gallos","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"R21-20260617","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1186\/s12913-023-09263-4","article-title":"Cost-effectiveness and budget impact of heat-stable carbetocin compared to oxytocin and misoprostol for the prevention of postpartum hemorrhage (PPH) in women giving birth in India","volume":"23","author":"Cook","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"R22-20260617","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1007\/s12630-015-0375-2","article-title":"Carbetocin at Cesarean delivery for labour arrest: A sequential allocation trial to determine the effective dose","volume":"62","author":"Nguyen-Lu","year":"2015","journal-title":"Can J Anaesth"},{"key":"R23-20260617","doi-asserted-by":"crossref","first-page":"797039","DOI":"10.3389\/fphys.2021.797039","article-title":"The role of vasopressin v2 receptor in drug-induced hyponatremia","volume":"12","author":"Kim","year":"2021","journal-title":"Front Physiol"}],"container-title":["Indian Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_391_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T18:28:33Z","timestamp":1787768913000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_391_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":20,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ija.ija_391_26","relation":{},"ISSN":["0019-5049","0976-2817"],"issn-type":[{"value":"0019-5049","type":"print"},{"value":"0976-2817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2026-03-11","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-28","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}