Caesarean section is a recognized risk factor for Post-Partum Haemorrhage (PPH) and the worldwide caesarean delivery rate is increasing. The caesarean section is an operation where about 750 to 1000ml of blood is lost. When this becomes more than 1000ml, it is called post partum haemorrhage. In developing countries, PPH is one of the main cause of maternal deaths. Uterine atony is most common cause of immediate heavy PPH. Main causes are: PPH due to retained placenta

PPH due to uterine atony occurring within 24 hours following delivery

Delayed and secondary PPH occurring after the first 24 hours following delivery

PPH due to a coagulation defects

The administration of oxytocin after the delivery of the neonate reduces the likelihood of PPH. However, the use of additional uterotonic medication is common, to arrest bleeding, or sometimes used prophylactically if there are anticipated risk factors for PPH.

Oxytocin is a neurohypophysial hormone primarily recognized for its role in parturition and lactation. It is widely used as a uterotonic agent to induce and augment labour, as well as to prevent postpartum haemorrhage. Its mechanism of action is complex and involves multiple pathways that regulate uterine contractility.

Carbetocin, a synthetic long-acting analogue of oxytocin, has emerged as a promising alternative due to its extended duration of action and efficacy in maintaining uterine contraction. Carbetocin functions by mimicking oxytocin, a naturally occurring hormone responsible for uterine contractions during labour and postpartum uterine involution. Its pharmacological mechanism involves the activation of oxytocin receptors in the myometrium, leading to sustained uterine contractions that prevent excessive bleeding.