Comparative Effectiveness of Uterotonic Agents for Postpartum Hemorrhage Prevention after Vaginal Delivery: A Retrospective Analysis of a Multicenter Prospective Cohort in Korea

Comparative Effectiveness of Uterotonic Agents for Postpartum Hemorrhage Prevention after Vaginal Delivery: A Retrospective Analysis of a Multicenter Prospective Cohort in Korea | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparative Effectiveness of Uterotonic Agents for Postpartum Hemorrhage Prevention after Vaginal Delivery: A Retrospective Analysis of a Multicenter Prospective Cohort in Korea Yoo Jin Lee, Jin Hoon Chung, Ji Hoi Kim, Hee Young Cho, Young Mi Jung, and 17 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9069155/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background To describe current practice patterns and compare the effectiveness and safety of uterotonic agents for postpartum hemorrhage prevention after vaginal delivery. Methods This retrospective study used data prospectively collected from a multicenter cohort derived from a registered clinical trial (NCT05122169) conducted at nine obstetric centers in South Korea between December 2021 and July 2025. Patterns of uterotonic agent use were described, followed by comparative analyses among women who underwent vaginal delivery. Postpartum hemorrhage–related outcomes, including hemoglobin decrease by ≥ 2 g/dL, blood transfusion, and invasive hemostatic interventions, were compared using unadjusted analyses and multivariable logistic regression. Results Carbetocin was the most frequently used uterotonic agent (47.8%) in 2,585 women. Its use as a monotherapy was associated with lower rates of hemoglobin decrease by ≥ 2 g/dL compared with oxytocin-only use. In multivariable analyses, carbetocin-only use tended to be associated with lower odds of hemoglobin decrease by ≥ 2 g/dL compared with oxytocin-only use, although without statistical significance. The use of carbetocin in combination with additional uterotonic agents was associated with higher odds of hemoglobin decrease by ≥ 2 g/dL compared with carbetocin-only use. Conclusions This study provides a comprehensive analysis of uterotonic agent use in Korean obstetric practice, offering an evidence-based insight into the clinical importance of carbetocin use in vaginal delivery. uterotonic agents postpartum hemorrhage carbetocin vaginal delivery Background Postpartum hemorrhage (PPH) is one of the most serious complications during the perinatal period, representing a leading cause of maternal mortality and morbidity worldwide [ 1 ]. According to a systematic review of 26 studies, the median near-miss ratio for PPH was 3 per 1000 live births, with an overall mortality index of 6.6% (range: 0.0–40.7%) [ 2 ]. The mortality index was the highest in low- and lower middle-income countries, where limited resources, delayed access to care, and staff shortage substantially contribute to poor outcomes. Overall, PPH remains the most frequent cause of obstetric hemorrhage, with uterine atony representing the predominant etiology [ 1 ]. However, advances in clinical practice, such as uterine artery embolization, surgical interventions, and standardized transfusion protocols, have reduced maternal deaths from PPH in high-income countries. Nevertheless, despite reduced mortality, challenges related to severe maternal morbidity after treatment for PPH remain a major concern [ 3 – 5 ]. Women who survive life-threatening PPH may develop infertility following embolization, hysterectomy, or renal impairment and psychological sequelae such as depression and post-traumatic stress disorder. These complications underscore the need for prevention strategies that not only reduce mortality but also minimize morbidity and improve quality of life. Therefore, international guidelines strongly recommend prophylactically using uterotonic agents after delivery to prevent PPH and avert progression to severe bleeding. Recent systematic reviews and meta-analyses have compared the effectiveness and safety of various uterotonic agents, with most studies focusing on their use after cesarean delivery [ 6 – 15 ]. More recently, a Cochrane review has summarized the evidence for uterotonic agents in both cesarean section and vaginal delivery [ 16 ]. Despite growing evidence, the choice of uterotonic agents in real-world practice varies considerably across countries and healthcare settings, resulting in a gap between published evidence and actual clinical use. Moreover, most existing studies have been limited to cesarean deliveries or conducted in non-Asian populations, whereas data in Asian countries, particularly for vaginal deliveries, remain scarce. To overcome this limitation, the present study analyzed data from a multicenter, prospective cohort in Korea to compare the effectiveness and safety profiles of uterotonic agents commonly used for PPH prevention after vaginal delivery. This study aims to describe current practice patterns and evaluate the effectiveness of uterotonic agents, focusing on their use after vaginal delivery. Methods Study design This retrospective study analyzed data prospectively collected from a multicenter cohort derived from a registered clinical trial conducted between December 2021 and July 2025 at the obstetric departments of nine centers in South Korea (ClinicalTrials.gov: NCT05122169; registration date: November 16, 2021): Asan Medical Center, Ewha Womans University Seoul Hospital, Korea University Guro Hospital, Korea University Anam Hospital, Samsung Medical Center, Seoul National University Hospital, Seoul National University Boramae Medical Center, Seoul National University Bundang Hospital, and Seoul St. Mary’s Hospital. The present study represents an observational secondary analysis of this cohort and did not involve randomization or trial allocation. Women with term singleton pregnancies who planned to deliver vaginally at the participating institutions were included. According to the original trial protocol, women with (1) a known allergy to chlorhexidine, alcohol, iodine, or shellfish and (2) evidence of perineal infection were excluded from the analysis. Our institutional review board approved the study protocol (approval number: 2022 − 1515). Maternal demographic and obstetric characteristics collected included maternal age, pre-pregnancy height and weight, parity (nulliparous or multiparous), mode of conception (natural conception, ovulation induction, intrauterine insemination, or in vitro fertilization), induction of labor, use of prostaglandin E2 or oxytocin for induction, premature membrane rupture, gestational hypertension, preeclampsia, mode of delivery (spontaneous vaginal delivery, operative vaginal delivery, or cesarean section), perineal laceration, gestational age at delivery, birth weight, neonatal sex, and Apgar scores at 1 and 5 minutes. The primary outcome was defined as PPH-related clinical outcomes, including hemoglobin decrease by ≥ 2 g/dL and ≥ 4 g/dL, requirement for any blood transfusion (including red blood cells, fresh frozen plasma, platelet concentrate, or cryoprecipitate), transfusion of ≥ 4 units of red blood cells, intrauterine balloon tamponade, uterine artery embolization, peripartum hysterectomy, and dilation and curettage. Statistical analysis Patterns of uterotonic agent use were first analyzed in the overall study population. The proportions of individual uterotonic regimens and the relative distribution of each agent within combination regimens were evaluated. For each uterotonic agent, the frequencies of single-agent and combination use were also assessed. For group-level comparisons, a comparative cohort was defined by including the six most frequently observed uterotonic regimens. Within this cohort, maternal and obstetric characteristics were summarized, and the primary outcome was analyzed. Three comparative analyses focused on women who underwent vaginal delivery were performed: (1) carbetocin only versus oxytocin only and versus no uterotonic agent to evaluate the effect of the most frequently used single agent; (2) carbetocin only versus carbetocin combined with additional agents to assess the need for escalation when carbetocin was used; and (3) carbetocin only versus methylergometrine combined with oxytocin to compare carbetocin with a combination regimen commonly recommended as first-line treatment in current guidelines. Categorical outcomes were compared using the chi-square test or Fisher’s exact test, as appropriate, based on expected cell counts. Multivariable logistic regression analyses were additionally performed to evaluate the association between uterotonic agents and a hemoglobin decrease by ≥ 2 g/dL after adjusting for maternal age, height, weight, parity, mode of conception, gestational age at delivery, premature membrane rupture, gestational hypertension, and preeclampsia/eclampsia. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. Results Distribution and patterns of uterotonic agent use A total of 2,585 women were enrolled in this study. Table 1 presents the distribution of uterotonic agents, including deliveries with and without uterotonic agent use, in the study population. Among the enrolled women, 87.2% received at least one uterotonic agent. The most commonly used regimen was carbetocin alone, which was administered in 1,236 cases (47.8%), followed by the combination of carbetocin, methylergometrine, and oxytocin in 335 cases (13.0%). Each rare regimen accounted for ≤ 0.5% of total deliveries, mainly comprising combinations involving nalador and/or misoprostol. Table 2 presents patterns of uterotonic agent use according to individual drugs, including single-agent use and combination regimens. Carbetocin was the most frequently used uterotonic agent overall, accounting for 88.7% of deliveries with uterotonic use, including 1,236 cases as a single agent and 766 cases as a combination with other agents. Oxytocin was the second most commonly used agent, accounting for 38.7% of deliveries with uterotonic use. It was more often administered as part of combination regimens than as a single agent (mean number of concomitant agents: 2.4). Among all uterotonic agents, carbetocin showed the lowest mean number of concomitant agents (1.6), whereas misoprostol demonstrated the highest degree of combination use, with a mean of 3.3 concomitant agents. Table 1 Distribution of uterotonic agents in the study population Regimen Number of cases, n Proportion of total deliveries (%) Proportion among deliveries with uterotonic use (%) Carbetocin 1236 47.8 54.8 Carbetocin & Methylergometrine & Oxytocin 335 13 14.9 No uterotonic agents 330 12.8 - Carbetocin & Oxytocin 297 11.5 13.2 Methylergometrine & Oxytocin 106 4.1 4.7 Oxytocin 93 3.6 4.1 Carbetocin & Methylergometrine 61 2.4 2.7 Methylergometrine 47 1.8 2.1 Carbetocin & Methylergometrine & Oxytocin & Sulprostone 19 0.7 0.8 Carbetocin & Methylergometrine & Sulprostone 17 0.7 0.8 Carbetocin & Nalador 10 0.4 0.4 Oxytocin & Carbetocin & Nalador 9 0.3 0.4 Carbetocin & Misoprostol 5 0.2 0.2 Oxytocin & Carbetocin & Methylergometrine & Misoprostol 5 0.2 0.2 Nalador 4 0.2 0.2 Oxytocin & Carbetocin & Methylergometrine & Nalador & Misoprostol 4 0.2 0.2 Rare regimens (n \(\le\) 2) 13 ≤ 0.5 ≤ 0.6 Table 2 Patterns of uterotonic agent use, including single and combination regimens Uterotonic agent Number of cases, n Used as single agent, n Used in combination, n Mean number of concomitant agents, n Proportion among deliveries with uterotonic use (%) Carbetocin 2002 1236 766 1.6 88.7 Oxytocin 872 93 779 2.4 38.7 Methylergometrine 594 47 547 2.6 26.3 Misoprostol 19 1 18 3.3 0.8 Sulprostone 67 4 63 3.1 3.0 Clinical characteristics according to uterotonic agent use in the comparative cohort The comparative cohort, which comprised the six most frequently observed uterotonic regimens, included 2,397 women, representing the majority of the overall study population (n = 2,397/2,585, 92.7%). Table 3 summarizes maternal and neonatal characteristics according to uterotonic agent use in the comparative cohort. Maternal age was comparable across uterotonic agent groups. Significant differences were observed in pre-pregnancy height, gestational age at delivery, and parity, as well as prevalence of premature membrane rupture, gestational hypertension, and preeclampsia, among groups. All variables presented in Table 3 were included in the multivariable analyses. Supplementary Table 1 provides other variables, such as the type of assisted reproductive technology, presence of gestational diabetes, mode of delivery, induction of labor, neonatal sex, and Apgar scores. Table 3 Maternal and neonatal characteristics by uterotonic agent use in the comparative cohort Group Total (n = 2397) Carbetocin (n = 1236) Carbetocin & Methylergometrine &Oxytocin (n = 335) Carbetocin &Oxytocin (n = 297) Methylergometrine &Oxytocin (n = 106) Oxytocin (n = 93) No uterotonic agents (n = 330) p-value Maternal age, years 33.7 (3.7) 33.8 (3.6) 33.40 (3.8) 33.7 (3.3) 33.8 (3.9) 33.9 (4.2) 33.5 (3.8) 0.551 Prepregnancy height, cm 162.6(5.3) 163.0 (5.3) 162.6 (5.3) 162.2 (5.2) 162.5 (5.6) 161.8 (4.6) 162.0 (5.1) 0.015 Prepregnancy weight, kg 58.0 (9.7) 58.4 (9.7) 58.0 (9.7) 57.4 (10.1) 55.5 (7.0) 58.0 (9.6) 58.0 (9.9) 0.068 Gestational age at delivery, weeks 38.7 (0.9) 38.73(0.9) 38.9 (1.0) 38.6 (1.0) 38.6 (0.9) 38.8 (0.9) 38.6 (1.0) 0.001 Birth weight, g 3184.7 (359.8) 3188.8 (355.2) 3208.6 (340.7) 3158.5 (382.4) 3132.5 (334.3) 3207.4 (447.50) 3178.9 (355.1) 0.318 Parity, n(%) < 0.001 Nulliparity 1652 (68.9) 802 (64.9) 236 (70.4) 188 (63.3) 76 (71.7) 77 (82.8) 273 (82.7) Primi/multiparity 745 (31.1) 434 (35.1) 99 (29.6) 109 (36.7) 30 (28.3) 16 (17.2) 57 (17.3) ART 362 (15.1) 176 (14.2) 63 (18.8) 41 (13.8) 14 (13.2) 17 (18.3) 51 (15.5) 0.331 PROM, n(%) 101 (4.2) 43 (3.5) 5 (1.5) 26 (8.8) 6 (5.7) 7 (7.5) 14 (4.2) < 0.001 Gestational hypertension, n(%) 13 (0.5) 2 (0.2) 0 (0.0) 6 (2.0) 0 (0.0) 1 (1.1) 4 (1.2) 0.001 Preeclampsia, n(%) 14 (0.6) 6 (0.5) 0 (0.0) 7 (2.4) 0 (0.0) 1 (1.1) 0 (0.0) 0.001 ART, Assisted reproductive Technology; PROM, Prelabor rupture of Membranes; Continuous variables are presented as mean ± standard deviation, and categorical variables as number (percentage). Table 4 Maternal outcomes related to postpartum hemorrhage by uterotonic agent use in the comparative cohort Group Carbetocin (n = 1236) Carbetocin & Methylergometrine &Oxytocin (n = 335) Carbetocin &Oxytocin (n = 297) Methylergometrine &Oxytocin (n = 106) Oxytocin (n = 93) No uterotonic agents (n = 330) p-value Hemoglobin drop ≥ 2 g/dL, n(%) 265 (21.4) 77 (23.0) 89 (30.0) 18 (17.0) 34 (36.6) 92 (27.9) < 0.001 Missing data, n(%) 31 (2.5) 0 (0.0) 0 (0.0) 2 (1.9) 2 (2.2) 11 (3.3) Hemoglobin drop ≥ 4 g/dL, n(%) 13 (1.1) 3 (0.9) 3 (1.0) 1 (0.9) 4 (4.3) 6 (1.8) 0.002 Missing data, n(%) 31 (2.5) 0 (0.0) 0 (0.0) 2 (1.9) 2 (2.2) 11 (3.3) Any blood transfusion, n(%) 24 (1.9) 7 (2.1) 7 (2.4) 5 (4.7) 4 (4.3) 10 (3.0) 0.335 Red blood cell transfusion, n(%) 23 (1.9) 7 (2.1) 7 (2.4) 5 (4.7) 4 (4.3) 10 (3.0) 0.286 Fresh frozen plasma transfusion, n(%) 9 (0.7) 2 (0.6) 0 (0.0) 1 (0.9) 0 (0.0) 5 (1.5) 0.308 Platelet concentrate transfusion, n(%) 1 (0.1) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 3 (0.9) 0.025 Cryoprecipitate transfusion, n(%) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) NA RBC transfusion ≥ 4 units, n(%) 5 (0.4) 0 (0.0) 1 (0.3) 1 (0.9) 0 (0.0) 3 (0.9) 0.484 Intrauterine balloon tamponade, n(%) 5 (0.4) 0 (0.0) 3 (1.0) 2 (1.9) 0 (0.0) 0 (0.0) 0.047 Uterine artery embolization, n(%) 2 (0.2) 0 (0.0) 1 (0.3) 2 (1.9) 0 (0.0) 0 (0.0) 0.006 Peripartum hysterectomy, n(%) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) NA Dilation and curettage, n(%) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) NA NA, not available; categorical variables as number (percentage). Table 4 summarizes maternal PPH-related outcomes according to uterotonic agent use in the comparative cohort. A hemoglobin decrease by ≥2g/dL occurred more frequently in the oxytocin-only group (36.6%) and less frequently in the methylergometrine plus oxytocin group (17.0%). A hemoglobin decrease by ≥ 4 g/dL was also more common in the oxytocin-only group (4.3%). The frequencies of additional postpartum interventions, including intrauterine balloon tamponade and uterine artery embolization, differed significantly among the groups. However, the overall incidence of these interventions was low, limiting further interpretation. Comparative analyses of postpartum hemorrhage outcomes according to uterotonic regimen Comparative analyses were mainly focused on carbetocin-based regimens, as carbetocin was the most frequently used uterotonic agent. Supplementary Tables 2–4 summarize outcomes in the overall comparative cohort, irrespective of mode of delivery. In the overall cohort, women who received carbetocin alone showed the lowest proportion of hemoglobin drop by ≥ 2 g/dL compared with those receiving oxytocin alone or no uterotonic agent (22.0% vs. 37.4% vs. 28.8%, p < 0.001; Supplementary Table 2). A similar pattern was observed for hemoglobin drop by ≥ 4 g/dL (1.1% vs. 4.4% vs. 1.9%, p = 0.027). Rates of blood transfusion and additional hemorrhage-related interventions did not differ significantly among the groups. When comparing carbetocin alone with carbetocin + additional uterotonic agents, a hemoglobin drop by ≥ 2 g/dL occurred less frequently in the carbetocin-only group (22.0% vs. 26.3%, p = 0.046), whereas other hemorrhage-related outcomes were comparable (Supplementary Table 3). Comparing carbetocin alone and methylergometrine + oxytocin, no statistically significant differences were observed in hemoglobin decline or transfusion outcomes, although uterine artery embolization was more frequently performed in the methylergometrine + oxytocin group (0.2% vs. 1.9%, p = 0.033; Supplementary Table 4). Tables 5 – 7 present analyses of women who underwent vaginal delivery. Among them, the proportion of hemoglobin drop by ≥ 2 g/dL was the lowest in the carbetocin-only group and highest in the oxytocin-only group (20.3% vs. 32.6% vs. 28.6%, p = 0.021; Table 5 ). Hemoglobin drop by ≥ 4 g/dL also occurred less frequently in the carbetocin-only group (0.8%) compared with the oxytocin-only group (4.3%) and the no-uterotonic group (0.0%; p = 0.019). Other PPH-related outcomes, including blood transfusion, intrauterine balloon tamponade, and uterine artery embolization, were infrequent and did not differ significantly among the groups. Comparing carbetocin alone with carbetocin + additional uterotonic agents, hemoglobin drop by ≥ 2 g/dL remained significantly less common in the carbetocin-only group (20.3% vs. 25.5%, p = 0.023), whereas no significant differences were observed for other PPH-related outcomes (Table 6 ). The comparison of carbetocin alone and methylergometrine + oxytocin showed no statistically significant differences for hemoglobin decline or intervention-related outcomes (Table 7 ). Table 5 Primary postpartum hemorrhage outcomes according to uterotonic regimen (Carbetocin only vs Oxytocin only vs no uterotonic agent) in the vaginal delivery group Group Carbetocin only Oxytocin only No uterotonic agents p-value Number of cases (n) n = 1054 n = 47 n = 124 Hemoglobin drop ≥ 2 g/dL, n(%) 209 (20.3) 15 (32.6) 34 (28.6) 0.021 Hemoglobin drop ≥ 4 g/dL, n(%) 8 (0.8) 2 (4.3) 0 (0.0) 0.019 Any blood transfusion, n(%) 17 (1.6) 2 (4.3) 1 (0.8) 0.280 Red blood cell transfusion, n(%) 16 (1.5) 2 (4.3) 1 (0.8) 0.258 Fresh frozen plasma transfusion, n(%) 7 (0.7) 0 (0.0) 1 (0.8) 0.701 Platelet concentrate transfusion, n(%) 1 (0.1) 0 (0.0) 0 (0.0) 1.000 RBC transfusion ≥ 4 units, n(%) 4 (0.4) 0 (0.0) 1 (0.8) 0.529 Intrauterine balloon tamponade, n(%) 4 (0.4) 0 (0.0) 0 (0.0) 1.000 Uterine artery embolization, n(%) 1 (0.1) 0 (0.0) 0 (0.0) 1.000 Table 6 Primary postpartum hemorrhage outcomes according to uterotonic regimen (Carbetocin only vs Carbetocin & additional agents) in the vaginal delivery group Group Carbetocin only Carbetocin & additional agents p-value Number of cases (n) n = 1054 n = 534 Hemoglobin drop ≥ 2 g/dL, n(%) 209 (20.3) 136 (25.5) 0.023 Hemoglobin drop ≥ 4 g/dL, n(%) 8 (0.8) 5 (0.9) 0.973 Any blood transfusion, n(%) 17 (1.6) 13 (2.4) 0.347 Red blood cell transfusion, n(%) 16 (1.5) 13 (2.4) 0.276 Fresh frozen plasma transfusion, n(%) 7 (0.7) 2 (0.4) 0.726 Platelet concentrate transfusion, n(%) 1 (0.1) 0 (0.0) 1.000 RBC transfusion ≥ 4 units, n(%) 4 (0.4) 1 (0.2) 0.669 Intrauterine balloon tamponade, n(%) 4 (0.4) 2 (0.4) 1.000 Uterine artery embolization, n(%) 1 (0.1) 1 (0.2) 1.000 Table 7 Primary postpartum hemorrhage outcomes according to uterotonic regimen (Carbetocin only vs Methylergometrine &Oxytocin) in the vaginal delivery group Group Carbetocin only Methylergometrine &Oxytocin p-value Number of cases (n) n = 1054 n = 83 Hemoglobin drop ≥ 2 g/dL, n(%) 209 (20.3) 13 (16.0) 0.436 Hemoglobin drop ≥ 4 g/dL, n(%) 8 (0.8) 1 (1.2) 1.000 Any blood transfusion, n(%) 17 (1.6) 4 (4.8) 0.096 Red blood cell transfusion, n(%) 16 (1.5) 4 (4.8) 0.077 Fresh frozen plasma transfusion, n(%) 7 (0.7) 0 (0.0) 1.000 Platelet concentrate transfusion, n(%) 1 (0.1) 0 (0.0) 1.000 RBC transfusion ≥ 4 units, n(%) 4 (0.4) 0 (0.0) 1.000 Intrauterine balloon tamponade, n(%) 4 (0.4) 1 (1.2) 0.316 Uterine artery embolization, n(%) 1 (0.1) 1 (1.2) 0.141 Multivariable logistic regression analysis of postpartum hemorrhage outcomes In multivariable logistic regression analyses among women who underwent vaginal delivery (Table 8 ), carbetocin-only use showed a tendency toward lower odds of hemoglobin drop by ≥ 2 g/dL compared with oxytocin-only use (aOR: 0.572; 95% CI: 0.299–1.096), although without statistical significance (p = 0.093). Similarly, no use of uterotonic agents was not significantly associated with hemoglobin drop by ≥ 2 g/dL compared with oxytocin-only use (aOR: 0.795; 95% CI: 0.375–1.684). In contrast, using carbetocin in combination with additional agents was associated with higher odds of hemoglobin drop by ≥ 2 g/dL compared with carbetocin-only use (aOR: 1.310; 95% CI: 1.016–1.690). The methylergometrine + oxytocin regimen showed a lower aOR of hemoglobin drop by ≥ 2 g/dL compared with carbetocin-only use (aOR: 0.700; 95% CI: 0.360–1.266); however, this difference was not statistically significant. Supplementary Table 5 summarizes the overall characteristics of women who underwent vaginal delivery, including the confounding factors used in the multivariable logistic regression analysis. Table 8 Multivariable logistic regression analysis of primary postpartum hemorrhage according to uterotonic regimen in the vaginal delivery group Group Reference Unadjusted OR (95% CI) p-value Adjusted OR (95% CI) p-value Carbetocin only Oxytocin only 0.527 (0.284–1.020) 0.048 0.572 (0.299–1.096) 0.093 No uterotonic agents Oxytocin only 0.827 (0.400–1.750) 0.611 0.795 (0.375–1.684) 0.549 Carbetocin & additional agents Carbetocin only 1.352 (1.055–1.732) 0.017 1.310 (1.016–1.690) 0.038 Methylergometrine &Oxytocin Carbetocin only 0.750 (0.390–1.339) 0.357 0.700 (0.360–1.266) 0.262 Discussion This multicenter study analyzed real-world data on uterotonic agent use for PPH prevention in South Korea. Among the uterotonic agents used in routine clinical practice, carbetocin was the most frequently used uterotonic agent (47.8% of deliveries), followed by combination regimens such as carbetocin + methylergometrine + oxytocin (13.0%) and carbetocin + oxytocin (11.5%). Notably, some women (12.8%) did not receive any uterotonic agent after delivery. This finding likely reflects heterogeneity in institutional protocols. The strong preference for carbetocin observed in this study may be partly explained by its several practical advantages over oxytocin, including single-dose administration and the avoidance of prolonged intravenous infusion. Additionally, cost-related differences between uterotonic agents may be less relevant under a bundled reimbursement system for delivery care in Korea. The efficacy of uterotonic agents for PPH prevention has been widely studied in various clinical settings. Available evidence consistently suggests that carbetocin provides efficacy comparable to that of oxytocin or oxytocin-based regimens in vaginal delivery. However, results from previous comparative studies are inconsistent. Several studies reported no significant difference in efficacy between carbetocin and oxytocin or syntometrine [ 12 , 17 – 20 ], while others concluded the non-inferiority of carbetocin [ 21 – 23 ]. Furthermore, some studies even suggested the superior effectiveness of carbetocin [ 24 – 26 ]. Notably, the 2025 Cochrane review demonstrated that carbetocin provides efficacy comparable to oxytocin for PPH prevention in vaginal delivery, with little-to-no difference in the risk of blood loss ≥ 500 mL or ≥ 1000 mL, while demonstrating a more favorable adverse effect profile [ 16 ]. Accordingly, the clinical effectiveness and optimal positioning of carbetocin require further clarification. In this context, the present study focused on evaluating the clinical effectiveness of carbetocin in routine clinical practice, focusing on vaginal delivery. In unadjusted comparisons of frequently used uterotonic regimens, oxytocin-only use was associated with less favorable PPH-related outcomes, such as higher rates of hemoglobin drop by ≥ 2 g/dL and ≥ 4 g/dL. However, combinations such as oxytocin + methylergometrine showed comparatively lower rates of these outcomes than other common regimens. These findings underscore the limitation of simple frequency-based comparisons, suggesting that these unadjusted analyses alone are insufficient to determine the effectiveness of individual uterotonic agents. This pattern was also observed in the overall cohort and remained consistent after adjustment for potential confounders in multivariable analyses. Importantly, these findings are based on routine clinical practice, distinguishing the present study from prior randomized controlled trials conducted under more controlled conditions. Regarding the need for additional uterotonic agents, the unfavorable outcomes observed in the combination therapy group may reflect the need for additional uterotonic agents in higher-risk clinical scenarios, rather than reduced drug efficacy. This represents an important consideration in interpreting our results. This study has several limitations. First, the number of cases in certain uterotonic regimen groups was relatively small, limiting statistical power for some comparisons. Second, this study lacked detailed information on the timing, sequence, and clinical indications for uterotonic agent use, representing a limitation inherent to its retrospective analysis, making it difficult to distinguish routine prophylactic use from reactive treatment. Third, the overall incidence of PPH-related outcomes was relatively low, limiting the ability to draw statistically significant conclusions. Conclusions This study provides a comprehensive analysis of uterotonic agent use in Korean obstetric practice, offering an evidence-based insight into the clinical importance of carbetocin in vaginal delivery. Furthermore, prospective studies incorporating safety outcomes may help establish more clinically actionable guidance on the optimal use of uterotonic agents for PPH prevention. Abbreviations PPH, postpartum hemorrhage aOR, adjusted odds ratio CI, confidence interval Declarations Ethics approval and consent to participate This study was conducted in accordance with the principles of the Declaration of Helsinki. The study used data from a registered clinical trial (ClinicalTrials.gov: NCT05122169; registration date: November 16, 2021). The study protocol was approved by our institutional review board (approval number: 2022 − 1515). Written informed consent was obtained from all participants prior to enrollment. Data confidentiality and anonymity were strictly maintained. Consent for publication Not applicable. Competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper Funding This research was supported by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number : RS-2021-KH120178). Author Contribution YJL and JHC conceptualized the study. YJL performed the methodology and drafted the manuscript. HSW and JSP supervised the study and reviewed the manuscript. All authors contributed to data acquisition and approved the final version of the manuscript. Acknowledgements Not applicable. Data Availability The datasets used for analysis of this study are available from the corresponding author upon reasonable request. References . Maswime S, Buchmann E. A systematic review of maternal near miss and mortality due to postpartum hemorrhage. 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Albazee E, Sadan M, Alenezi AM, Almutairi AN, Alenezi MM, Almonayea LE. Efficacy and Safety of Carbetocin Versus Misoprostol in Cesarean Section: A Systematic Review and Meta-Analysis. Cureus. 2022;14(12):e32901. Amaral S, Provinciatto H, Gewehr DM, Lombardi RA, D'Souza RS, Terres MT, Pereira EMM, da Silveira CAB, Assis MLM, Pereira LC, et al. Prophylactic strategies for prevention of postpartum haemorrhage in caesarean delivery: a systematic review and Bayesian network meta-analysis of randomised controlled trials. Lancet Glob Health. 2025;13(8):e1415–24. Cole NM, Kim JJ, Lumbreras-Marquez MI, Fields KG, Mendez-Pino L, Farber MK, Carusi DA, Toledo P, Bateman BT. Second-Line Uterotonics for Uterine Atony: A Randomized Controlled Trial. Obstet Gynecol. 2024;144(6):832–41. El-Goly NA, Maged AM, Kamal WM, Hosny O, Turki D, Helmy NM. Carbetocin versus oxytocin in prevention of postpartum hemorrhage after cesarean delivery in high-risk women. A systematic review and meta-analysis. Arch Gynecol Obstet. 2025;312(2):291–309. Jaffer D, Singh PM, Aslam A, Cahill AG, Palanisamy A, Monks DT. Preventing postpartum hemorrhage after cesarean delivery: a network meta-analysis of available pharmacologic agents. Am J Obstet Gynecol. 2022;226(3):347–65. Kalafat E, Gokce A, O'Brien P, Benlioglu C, Koc A, Karaaslan O, Khalil A. Efficacy of carbetocin in the prevention of postpartum hemorrhage: a systematic review and Bayesian meta-analysis of randomized trials. J Matern Fetal Neonatal Med. 2021;34(14):2303–16. Maged AM, El-Goly NA, Turki D, Bassiouny N, El-Demiry N. 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. J Obstet Gynaecol Res. 2025;51(1):e16194. Zorlu U, Elmas B, Türker Ergün G, Turgay B, Salman Özgü B, Karagöz Ç, Kurtaran G. Moraloğlu Tekin Ö: Carbetocin versus Oxytocin-Based Regimens in Macrosomic Births: A Comparative Hemodynamic Perspective. Bratislava Med J. 2025;126(12):3527–33. Samimi M, Hosseiniara R, Akbari H, Beyrami D. Carbetocin versus oxytocin with or without tranexamic acid for preventing postpartum hemorrhage in cesarean delivery: a randomized controlled trial. BMC Pregnancy Childbirth. 2026;26(1):183. Gallos ID, Yunas I, Devall AJ, Podesek M, Tobias A, Price MJ, Oladapo OT, Coomarasamy A. Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. Cochrane Database Syst Rev. 2025;4(4):CD011689. Korb D, Lopez R, Horlin AL, Schmitz T, Borie C, Sibony O. Effectiveness of prophylactic carbetocin versus oxytocin following vaginal delivery for preventing severe postpartum hemorrhage. Int J Gynaecol Obstet. 2023;162(3):889–94. Liu H, Xu X-Y, Gu N, Ye X-D, Wang Z-Q, Hu Y-L, Dai Y-M. Intravenous Administration of Carbetocin Versus Oxytocin for Preventing Postpartum Hemorrhage After Vaginal Delivery in High Risk Women: A Double-blind, Randomized Controlled Trial. Maternal-Fetal Med. 2020;2(2):72–9. Su LL, Rauff M, Chan YH, Mohamad Suphan N, Lau TP, Biswas A, Chong YS. Carbetocin versus syntometrine for the third stage of labour following vaginal delivery–a double-blind randomised controlled trial. BJOG. 2009;116(11):1461–6. Whigham CA, Gorelik A, Loughnan TE, Trivedi A. Carbetocin versus oxytocin to reduce additional uterotonic use at non-elective caesarean section: a double-blind, randomised trial (). J Matern Fetal Neonatal Med. 2016;29(23):3866–9. Jin XH, Li D, Li X. Carbetocin vs oxytocin for prevention of postpartum hemorrhage after vaginal delivery: A meta-analysis. Med (Baltim). 2019;98(47):e17911. van der Nelson H, O'Brien S, Burnard S, Mayer M, Alvarez M, Knowlden J, Winter C, Dailami N, Marques E, Burden C, et al. Intramuscular oxytocin versus Syntometrine((R)) versus carbetocin for prevention of primary postpartum haemorrhage after vaginal birth: a randomised double-blinded clinical trial of effectiveness, side effects and quality of life. BJOG. 2021;128(7):1236–46. Widmer M, Piaggio G, Nguyen TMH, Osoti A, Owa OO, Misra S, Coomarasamy A, Abdel-Aleem H, Mallapur AA, Qureshi Z, et al. Heat-Stable Carbetocin versus Oxytocin to Prevent Hemorrhage after Vaginal Birth. N Engl J Med. 2018;379(8):743–52. Huang X, Xue W, Zhou J, Zhou C, Yang F. Effect of Carbetocin on Postpartum Hemorrhage after Vaginal Delivery: A Meta-Analysis. Comput Math Methods Med 2022, 2022:6420738. McKimmie-Doherty M, Vasilevski V, De Luca L, McDonald E, Grainger T, Nash L, Sweet L. Carbetocin for Postpartum Haemorrhage Prophylaxis in All Births: A Retrospective Cohort Study Following Policy Change in Routine Uterotonic Use. BJOG. 2026;133(2):293–301. Tai K, Barman K, Das R, Mili T, Chowdhury N. Comparison of intravenous carbetocin versus intramuscular oxytocin in management of third stage of labour in vaginal delivery. New Indian J OBGYN. 2024;10(2):300–4. Additional Declarations No competing interests reported. Supplementary Files NECAUterotonicagentSupplementaryTableV10204.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 21 Apr, 2026 Reviewers agreed at journal 14 Apr, 2026 Reviews received at journal 11 Apr, 2026 Reviewers agreed at journal 10 Apr, 2026 Reviewers agreed at journal 09 Apr, 2026 Reviewers invited by journal 07 Apr, 2026 Editor assigned by journal 06 Apr, 2026 Editor invited by journal 16 Mar, 2026 Submission checks completed at journal 12 Mar, 2026 First submitted to journal 12 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9069155","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":622233915,"identity":"095300cc-c297-4b2d-ad88-d6541be4b3f3","order_by":0,"name":"Yoo Jin Lee","email":"","orcid":"","institution":"University of Ulsan","correspondingAuthor":false,"prefix":"","firstName":"Yoo","middleName":"Jin","lastName":"Lee","suffix":""},{"id":622233918,"identity":"1f84f8f8-fb36-4222-b411-894a1cbc20b8","order_by":1,"name":"Jin Hoon Chung","email":"","orcid":"","institution":"University of 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20:00:10","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":39208,"visible":true,"origin":"","legend":"","description":"","filename":"NECAUterotonicagentSupplementaryTableV10204.docx","url":"https://assets-eu.researchsquare.com/files/rs-9069155/v1/76faba370aa804fc08a06f38.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Effectiveness of Uterotonic Agents for Postpartum Hemorrhage Prevention after Vaginal Delivery: A Retrospective Analysis of a Multicenter Prospective Cohort in Korea","fulltext":[{"header":"Background","content":"\u003cp\u003ePostpartum hemorrhage (PPH) is one of the most serious complications during the perinatal period, representing a leading cause of maternal mortality and morbidity worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to a systematic review of 26 studies, the median near-miss ratio for PPH was 3 per 1000 live births, with an overall mortality index of 6.6% (range: 0.0\u0026ndash;40.7%) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The mortality index was the highest in low- and lower middle-income countries, where limited resources, delayed access to care, and staff shortage substantially contribute to poor outcomes. Overall, PPH remains the most frequent cause of obstetric hemorrhage, with uterine atony representing the predominant etiology [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, advances in clinical practice, such as uterine artery embolization, surgical interventions, and standardized transfusion protocols, have reduced maternal deaths from PPH in high-income countries. Nevertheless, despite reduced mortality, challenges related to severe maternal morbidity after treatment for PPH remain a major concern [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Women who survive life-threatening PPH may develop infertility following embolization, hysterectomy, or renal impairment and psychological sequelae such as depression and post-traumatic stress disorder. These complications underscore the need for prevention strategies that not only reduce mortality but also minimize morbidity and improve quality of life. Therefore, international guidelines strongly recommend prophylactically using uterotonic agents after delivery to prevent PPH and avert progression to severe bleeding.\u003c/p\u003e \u003cp\u003eRecent systematic reviews and meta-analyses have compared the effectiveness and safety of various uterotonic agents, with most studies focusing on their use after cesarean delivery [\u003cspan additionalcitationids=\"CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. More recently, a Cochrane review has summarized the evidence for uterotonic agents in both cesarean section and vaginal delivery [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite growing evidence, the choice of uterotonic agents in real-world practice varies considerably across countries and healthcare settings, resulting in a gap between published evidence and actual clinical use. Moreover, most existing studies have been limited to cesarean deliveries or conducted in non-Asian populations, whereas data in Asian countries, particularly for vaginal deliveries, remain scarce.\u003c/p\u003e \u003cp\u003eTo overcome this limitation, the present study analyzed data from a multicenter, prospective cohort in Korea to compare the effectiveness and safety profiles of uterotonic agents commonly used for PPH prevention after vaginal delivery. This study aims to describe current practice patterns and evaluate the effectiveness of uterotonic agents, focusing on their use after vaginal delivery.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis retrospective study analyzed data prospectively collected from a multicenter cohort derived from a registered clinical trial conducted between December 2021 and July 2025 at the obstetric departments of nine centers in South Korea (ClinicalTrials.gov: NCT05122169; registration date: November 16, 2021): Asan Medical Center, Ewha Womans University Seoul Hospital, Korea University Guro Hospital, Korea University Anam Hospital, Samsung Medical Center, Seoul National University Hospital, Seoul National University Boramae Medical Center, Seoul National University Bundang Hospital, and Seoul St. Mary\u0026rsquo;s Hospital. The present study represents an observational secondary analysis of this cohort and did not involve randomization or trial allocation. Women with term singleton pregnancies who planned to deliver vaginally at the participating institutions were included. According to the original trial protocol, women with (1) a known allergy to chlorhexidine, alcohol, iodine, or shellfish and (2) evidence of perineal infection were excluded from the analysis. Our institutional review board approved the study protocol (approval number: 2022\u0026thinsp;\u0026minus;\u0026thinsp;1515).\u003c/p\u003e \u003cp\u003eMaternal demographic and obstetric characteristics collected included maternal age, pre-pregnancy height and weight, parity (nulliparous or multiparous), mode of conception (natural conception, ovulation induction, intrauterine insemination, or \u003cem\u003ein vitro\u003c/em\u003e fertilization), induction of labor, use of prostaglandin E2 or oxytocin for induction, premature membrane rupture, gestational hypertension, preeclampsia, mode of delivery (spontaneous vaginal delivery, operative vaginal delivery, or cesarean section), perineal laceration, gestational age at delivery, birth weight, neonatal sex, and Apgar scores at 1 and 5 minutes.\u003c/p\u003e \u003cp\u003eThe primary outcome was defined as PPH-related clinical outcomes, including hemoglobin decrease by \u0026ge;\u0026thinsp;2 g/dL and \u0026ge;\u0026thinsp;4 g/dL, requirement for any blood transfusion (including red blood cells, fresh frozen plasma, platelet concentrate, or cryoprecipitate), transfusion of \u0026ge;\u0026thinsp;4 units of red blood cells, intrauterine balloon tamponade, uterine artery embolization, peripartum hysterectomy, and dilation and curettage.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003ePatterns of uterotonic agent use were first analyzed in the overall study population. The proportions of individual uterotonic regimens and the relative distribution of each agent within combination regimens were evaluated. For each uterotonic agent, the frequencies of single-agent and combination use were also assessed. For group-level comparisons, a comparative cohort was defined by including the six most frequently observed uterotonic regimens. Within this cohort, maternal and obstetric characteristics were summarized, and the primary outcome was analyzed.\u003c/p\u003e \u003cp\u003e Three comparative analyses focused on women who underwent vaginal delivery were performed: (1) carbetocin only versus oxytocin only and versus no uterotonic agent to evaluate the effect of the most frequently used single agent; (2) carbetocin only versus carbetocin combined with additional agents to assess the need for escalation when carbetocin was used; and (3) carbetocin only versus methylergometrine combined with oxytocin to compare carbetocin with a combination regimen commonly recommended as first-line treatment in current guidelines. Categorical outcomes were compared using the chi-square test or Fisher\u0026rsquo;s exact test, as appropriate, based on expected cell counts.\u003c/p\u003e \u003cp\u003eMultivariable logistic regression analyses were additionally performed to evaluate the association between uterotonic agents and a hemoglobin decrease by \u0026ge;\u0026thinsp;2 g/dL after adjusting for maternal age, height, weight, parity, mode of conception, gestational age at delivery, premature membrane rupture, gestational hypertension, and preeclampsia/eclampsia. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eDistribution and patterns of uterotonic agent use\u003c/h2\u003e \u003cp\u003eA total of 2,585 women were enrolled in this study. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the distribution of uterotonic agents, including deliveries with and without uterotonic agent use, in the study population. Among the enrolled women, 87.2% received at least one uterotonic agent. The most commonly used regimen was carbetocin alone, which was administered in 1,236 cases (47.8%), followed by the combination of carbetocin, methylergometrine, and oxytocin in 335 cases (13.0%). Each rare regimen accounted for \u0026le;\u0026thinsp;0.5% of total deliveries, mainly comprising combinations involving nalador and/or misoprostol. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents patterns of uterotonic agent use according to individual drugs, including single-agent use and combination regimens. Carbetocin was the most frequently used uterotonic agent overall, accounting for 88.7% of deliveries with uterotonic use, including 1,236 cases as a single agent and 766 cases as a combination with other agents. Oxytocin was the second most commonly used agent, accounting for 38.7% of deliveries with uterotonic use. It was more often administered as part of combination regimens than as a single agent (mean number of concomitant agents: 2.4). Among all uterotonic agents, carbetocin showed the lowest mean number of concomitant agents (1.6), whereas misoprostol demonstrated the highest degree of combination use, with a mean of 3.3 concomitant agents.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of uterotonic agents in the study population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegimen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of cases, n\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProportion of total deliveries (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eProportion among deliveries with uterotonic use (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbetocin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbetocin \u0026amp; Methylergometrine \u0026amp; Oxytocin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo uterotonic agents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbetocin \u0026amp; Oxytocin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMethylergometrine \u0026amp; Oxytocin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxytocin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbetocin \u0026amp; Methylergometrine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMethylergometrine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbetocin \u0026amp; Methylergometrine\u003c/p\u003e \u003cp\u003e\u0026amp; Oxytocin \u0026amp; Sulprostone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbetocin \u0026amp; Methylergometrine \u0026amp; Sulprostone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbetocin \u0026amp; Nalador\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxytocin \u0026amp; Carbetocin \u0026amp; Nalador\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbetocin \u0026amp; Misoprostol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxytocin \u0026amp; Carbetocin \u0026amp; Methylergometrine \u0026amp; Misoprostol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNalador\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxytocin \u0026amp; Carbetocin \u0026amp; Methylergometrine \u0026amp; Nalador \u0026amp; Misoprostol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRare regimens (n\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\le\\)\u003c/span\u003e\u003c/span\u003e2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatterns of uterotonic agent use, including single and combination regimens\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUterotonic agent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of cases, n\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUsed as single agent, n\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUsed in combination, n\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean number of concomitant agents, n\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eProportion among deliveries with uterotonic use (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbetocin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e766\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e88.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxytocin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e872\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e779\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e38.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMethylergometrine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e26.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMisoprostol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSulprostone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eClinical characteristics according to uterotonic agent use in the comparative cohort\u003c/h3\u003e\n\u003cp\u003eThe comparative cohort, which comprised the six most frequently observed uterotonic regimens, included 2,397 women, representing the majority of the overall study population (n\u0026thinsp;=\u0026thinsp;2,397/2,585, 92.7%). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarizes maternal and neonatal characteristics according to uterotonic agent use in the comparative cohort. Maternal age was comparable across uterotonic agent groups. Significant differences were observed in pre-pregnancy height, gestational age at delivery, and parity, as well as prevalence of premature membrane rupture, gestational hypertension, and preeclampsia, among groups. All variables presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e were included in the multivariable analyses. Supplementary Table\u0026nbsp;1 provides other variables, such as the type of assisted reproductive technology, presence of gestational diabetes, mode of delivery, induction of labor, neonatal sex, and Apgar scores.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMaternal and neonatal characteristics by uterotonic agent use in the comparative cohort\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;2397)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCarbetocin (n\u0026thinsp;=\u0026thinsp;1236)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCarbetocin \u0026amp; Methylergometrine \u0026amp;Oxytocin (n\u0026thinsp;=\u0026thinsp;335)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCarbetocin\u003c/p\u003e \u003cp\u003e\u0026amp;Oxytocin\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;297)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMethylergometrine\u003c/p\u003e \u003cp\u003e\u0026amp;Oxytocin (n\u0026thinsp;=\u0026thinsp;106)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOxytocin\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;93)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo uterotonic agents (n\u0026thinsp;=\u0026thinsp;330)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal age,\u003c/p\u003e \u003cp\u003eyears\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.7 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.8 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.40 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.7 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.8 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33.9 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e33.5 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.551\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrepregnancy height, cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e162.6(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163.0 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e162.6 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e162.2 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e162.5 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e161.8 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e162.0 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrepregnancy weight, kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.0 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.4 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.0 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.4 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e55.5 (7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e58.0 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e58.0 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational age at\u003c/p\u003e \u003cp\u003edelivery, weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.7 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.73(0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.9 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38.6 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38.6 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e38.8 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e38.6 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth weight, g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3184.7 (359.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3188.8 (355.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3208.6 (340.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3158.5 (382.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3132.5 (334.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3207.4 (447.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3178.9 (355.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNulliparity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1652 (68.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e802 (64.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e236 (70.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e188 (63.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76 (71.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e77 (82.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e273 (82.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimi/multiparity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e745 (31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e434 (35.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99 (29.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e109 (36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30 (28.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e57 (17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e362 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e176 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63 (18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17 (18.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e51 (15.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.331\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePROM, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e14 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational\u003c/p\u003e \u003cp\u003ehypertension, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreeclampsia, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eART, Assisted reproductive Technology; PROM, Prelabor rupture of Membranes; Continuous variables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, and categorical variables as number (percentage).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMaternal outcomes related to postpartum hemorrhage by uterotonic agent use in the comparative cohort\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCarbetocin (n\u0026thinsp;=\u0026thinsp;1236)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCarbetocin \u0026amp; Methylergometrine \u0026amp;Oxytocin (n\u0026thinsp;=\u0026thinsp;335)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCarbetocin\u003c/p\u003e \u003cp\u003e\u0026amp;Oxytocin\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;297)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMethylergometrine\u003c/p\u003e \u003cp\u003e\u0026amp;Oxytocin (n\u0026thinsp;=\u0026thinsp;106)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOxytocin\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;93)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo uterotonic agents (n\u0026thinsp;=\u0026thinsp;330)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin drop\u0026thinsp;\u0026ge;\u0026thinsp;2 g/dL, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e265 (21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (17.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34 (36.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e92 (27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing data, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin drop\u0026thinsp;\u0026ge;\u0026thinsp;4 g/dL, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing data, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny blood transfusion, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10 (3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.335\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRed blood cell transfusion, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10 (3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.286\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFresh frozen plasma transfusion, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.308\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelet concentrate transfusion, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCryoprecipitate transfusion, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRBC transfusion\u0026thinsp;\u0026ge;\u0026thinsp;4 units, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.484\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrauterine balloon tamponade, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUterine artery embolization, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeripartum hysterectomy, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDilation and curettage, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eNA, not available; categorical variables as number (percentage).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e summarizes maternal PPH-related outcomes according to uterotonic agent use in the comparative cohort. A hemoglobin decrease by \u0026ge;2g/dL occurred more frequently in the oxytocin-only group (36.6%) and less frequently in the methylergometrine plus oxytocin group (17.0%). A hemoglobin decrease by \u0026ge;\u0026thinsp;4 g/dL was also more common in the oxytocin-only group (4.3%). The frequencies of additional postpartum interventions, including intrauterine balloon tamponade and uterine artery embolization, differed significantly among the groups. However, the overall incidence of these interventions was low, limiting further interpretation.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eComparative analyses of postpartum hemorrhage outcomes according to uterotonic regimen\u003c/h2\u003e \u003cp\u003eComparative analyses were mainly focused on carbetocin-based regimens, as carbetocin was the most frequently used uterotonic agent. Supplementary Tables\u0026nbsp;2\u0026ndash;4 summarize outcomes in the overall comparative cohort, irrespective of mode of delivery. In the overall cohort, women who received carbetocin alone showed the lowest proportion of hemoglobin drop by \u0026ge;\u0026thinsp;2 g/dL compared with those receiving oxytocin alone or no uterotonic agent (22.0% vs. 37.4% vs. 28.8%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Supplementary Table\u0026nbsp;2). A similar pattern was observed for hemoglobin drop by \u0026ge;\u0026thinsp;4 g/dL (1.1% vs. 4.4% vs. 1.9%, p\u0026thinsp;=\u0026thinsp;0.027). Rates of blood transfusion and additional hemorrhage-related interventions did not differ significantly among the groups.\u003c/p\u003e \u003cp\u003eWhen comparing carbetocin alone with carbetocin\u0026thinsp;+\u0026thinsp;additional uterotonic agents, a hemoglobin drop by \u0026ge;\u0026thinsp;2 g/dL occurred less frequently in the carbetocin-only group (22.0% vs. 26.3%, p\u0026thinsp;=\u0026thinsp;0.046), whereas other hemorrhage-related outcomes were comparable (Supplementary Table\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eComparing carbetocin alone and methylergometrine\u0026thinsp;+\u0026thinsp;oxytocin, no statistically significant differences were observed in hemoglobin decline or transfusion outcomes, although uterine artery embolization was more frequently performed in the methylergometrine\u0026thinsp;+\u0026thinsp;oxytocin group (0.2% vs. 1.9%, p\u0026thinsp;=\u0026thinsp;0.033; Supplementary Table\u0026nbsp;4).\u003c/p\u003e \u003cp\u003eTables\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e present analyses of women who underwent vaginal delivery. Among them, the proportion of hemoglobin drop by \u0026ge;\u0026thinsp;2 g/dL was the lowest in the carbetocin-only group and highest in the oxytocin-only group (20.3% vs. 32.6% vs. 28.6%, p\u0026thinsp;=\u0026thinsp;0.021; Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Hemoglobin drop by \u0026ge;\u0026thinsp;4 g/dL also occurred less frequently in the carbetocin-only group (0.8%) compared with the oxytocin-only group (4.3%) and the no-uterotonic group (0.0%; p\u0026thinsp;=\u0026thinsp;0.019). Other PPH-related outcomes, including blood transfusion, intrauterine balloon tamponade, and uterine artery embolization, were infrequent and did not differ significantly among the groups. Comparing carbetocin alone with carbetocin\u0026thinsp;+\u0026thinsp;additional uterotonic agents, hemoglobin drop by \u0026ge;\u0026thinsp;2 g/dL remained significantly less common in the carbetocin-only group (20.3% vs. 25.5%, p\u0026thinsp;=\u0026thinsp;0.023), whereas no significant differences were observed for other PPH-related outcomes (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). The comparison of carbetocin alone and methylergometrine\u0026thinsp;+\u0026thinsp;oxytocin showed no statistically significant differences for hemoglobin decline or intervention-related outcomes (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrimary postpartum hemorrhage outcomes according to uterotonic regimen (Carbetocin only vs Oxytocin only vs no uterotonic agent) in the vaginal delivery group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCarbetocin only\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOxytocin only\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo uterotonic agents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of cases (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;1054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin drop\u0026thinsp;\u0026ge;\u0026thinsp;2 g/dL, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e209 (20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin drop\u0026thinsp;\u0026ge;\u0026thinsp;4 g/dL, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny blood transfusion, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.280\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRed blood cell transfusion, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.258\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFresh frozen plasma transfusion, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.701\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelet concentrate transfusion, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRBC transfusion\u0026thinsp;\u0026ge;\u0026thinsp;4 units, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.529\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrauterine balloon tamponade, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUterine artery embolization, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrimary postpartum hemorrhage outcomes according to uterotonic regimen (Carbetocin only vs Carbetocin \u0026amp; additional agents) in the vaginal delivery group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCarbetocin only\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCarbetocin \u0026amp; additional agents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of cases (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;1054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin drop\u0026thinsp;\u0026ge;\u0026thinsp;2 g/dL, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e209 (20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136 (25.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin drop\u0026thinsp;\u0026ge;\u0026thinsp;4 g/dL, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.973\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny blood transfusion, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.347\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRed blood cell transfusion, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.276\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFresh frozen plasma transfusion, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.726\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelet concentrate transfusion, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRBC transfusion\u0026thinsp;\u0026ge;\u0026thinsp;4 units, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.669\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrauterine balloon tamponade, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUterine artery embolization, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrimary postpartum hemorrhage outcomes according to uterotonic regimen (Carbetocin only vs Methylergometrine \u0026amp;Oxytocin) in the vaginal delivery group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCarbetocin only\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMethylergometrine \u0026amp;Oxytocin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of cases (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;1054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin drop\u0026thinsp;\u0026ge;\u0026thinsp;2 g/dL, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e209 (20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.436\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin drop\u0026thinsp;\u0026ge;\u0026thinsp;4 g/dL, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny blood transfusion, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRed blood cell transfusion, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFresh frozen plasma transfusion, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelet concentrate transfusion, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRBC transfusion\u0026thinsp;\u0026ge;\u0026thinsp;4 units, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrauterine balloon tamponade, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.316\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUterine artery embolization, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMultivariable logistic regression analysis of postpartum hemorrhage outcomes\u003c/h3\u003e\n\u003cp\u003eIn multivariable logistic regression analyses among women who underwent vaginal delivery (Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e), carbetocin-only use showed a tendency toward lower odds of hemoglobin drop by \u0026ge;\u0026thinsp;2 g/dL compared with oxytocin-only use (aOR: 0.572; 95% CI: 0.299\u0026ndash;1.096), although without statistical significance (p\u0026thinsp;=\u0026thinsp;0.093). Similarly, no use of uterotonic agents was not significantly associated with hemoglobin drop by \u0026ge;\u0026thinsp;2 g/dL compared with oxytocin-only use (aOR: 0.795; 95% CI: 0.375\u0026ndash;1.684). In contrast, using carbetocin in combination with additional agents was associated with higher odds of hemoglobin drop by \u0026ge;\u0026thinsp;2 g/dL compared with carbetocin-only use (aOR: 1.310; 95% CI: 1.016\u0026ndash;1.690). The methylergometrine\u0026thinsp;+\u0026thinsp;oxytocin regimen showed a lower aOR of hemoglobin drop by \u0026ge;\u0026thinsp;2 g/dL compared with carbetocin-only use (aOR: 0.700; 95% CI: 0.360\u0026ndash;1.266); however, this difference was not statistically significant. Supplementary Table\u0026nbsp;5 summarizes the overall characteristics of women who underwent vaginal delivery, including the confounding factors used in the multivariable logistic regression analysis.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable logistic regression analysis of primary postpartum hemorrhage according to uterotonic regimen in the vaginal delivery group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnadjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbetocin only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOxytocin only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.527 (0.284\u0026ndash;1.020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.572 (0.299\u0026ndash;1.096)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo uterotonic agents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOxytocin only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.827 (0.400\u0026ndash;1.750)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.795 (0.375\u0026ndash;1.684)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.549\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbetocin \u0026amp; additional agents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCarbetocin only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.352 (1.055\u0026ndash;1.732)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.310 (1.016\u0026ndash;1.690)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMethylergometrine \u0026amp;Oxytocin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCarbetocin only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.750 (0.390\u0026ndash;1.339)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.357\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.700 (0.360\u0026ndash;1.266)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.262\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis multicenter study analyzed real-world data on uterotonic agent use for PPH prevention in South Korea. Among the uterotonic agents used in routine clinical practice, carbetocin was the most frequently used uterotonic agent (47.8% of deliveries), followed by combination regimens such as carbetocin\u0026thinsp;+\u0026thinsp;methylergometrine\u0026thinsp;+\u0026thinsp;oxytocin (13.0%) and carbetocin\u0026thinsp;+\u0026thinsp;oxytocin (11.5%). Notably, some women (12.8%) did not receive any uterotonic agent after delivery. This finding likely reflects heterogeneity in institutional protocols. The strong preference for carbetocin observed in this study may be partly explained by its several practical advantages over oxytocin, including single-dose administration and the avoidance of prolonged intravenous infusion. Additionally, cost-related differences between uterotonic agents may be less relevant under a bundled reimbursement system for delivery care in Korea.\u003c/p\u003e \u003cp\u003eThe efficacy of uterotonic agents for PPH prevention has been widely studied in various clinical settings. Available evidence consistently suggests that carbetocin provides efficacy comparable to that of oxytocin or oxytocin-based regimens in vaginal delivery. However, results from previous comparative studies are inconsistent. Several studies reported no significant difference in efficacy between carbetocin and oxytocin or syntometrine [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], while others concluded the non-inferiority of carbetocin [\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Furthermore, some studies even suggested the superior effectiveness of carbetocin [\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Notably, the 2025 Cochrane review demonstrated that carbetocin provides efficacy comparable to oxytocin for PPH prevention in vaginal delivery, with little-to-no difference in the risk of blood loss\u0026thinsp;\u0026ge;\u0026thinsp;500 mL or \u0026ge;\u0026thinsp;1000 mL, while demonstrating a more favorable adverse effect profile [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Accordingly, the clinical effectiveness and optimal positioning of carbetocin require further clarification.\u003c/p\u003e \u003cp\u003eIn this context, the present study focused on evaluating the clinical effectiveness of carbetocin in routine clinical practice, focusing on vaginal delivery. In unadjusted comparisons of frequently used uterotonic regimens, oxytocin-only use was associated with less favorable PPH-related outcomes, such as higher rates of hemoglobin drop by \u0026ge;\u0026thinsp;2 g/dL and \u0026ge;\u0026thinsp;4 g/dL. However, combinations such as oxytocin\u0026thinsp;+\u0026thinsp;methylergometrine showed comparatively lower rates of these outcomes than other common regimens. These findings underscore the limitation of simple frequency-based comparisons, suggesting that these unadjusted analyses alone are insufficient to determine the effectiveness of individual uterotonic agents. This pattern was also observed in the overall cohort and remained consistent after adjustment for potential confounders in multivariable analyses. Importantly, these findings are based on routine clinical practice, distinguishing the present study from prior randomized controlled trials conducted under more controlled conditions.\u003c/p\u003e \u003cp\u003eRegarding the need for additional uterotonic agents, the unfavorable outcomes observed in the combination therapy group may reflect the need for additional uterotonic agents in higher-risk clinical scenarios, rather than reduced drug efficacy. This represents an important consideration in interpreting our results.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, the number of cases in certain uterotonic regimen groups was relatively small, limiting statistical power for some comparisons. Second, this study lacked detailed information on the timing, sequence, and clinical indications for uterotonic agent use, representing a limitation inherent to its retrospective analysis, making it difficult to distinguish routine prophylactic use from reactive treatment. Third, the overall incidence of PPH-related outcomes was relatively low, limiting the ability to draw statistically significant conclusions.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study provides a comprehensive analysis of uterotonic agent use in Korean obstetric practice, offering an evidence-based insight into the clinical importance of carbetocin in vaginal delivery. Furthermore, prospective studies incorporating safety outcomes may help establish more clinically actionable guidance on the optimal use of uterotonic agents for PPH prevention.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePPH, postpartum hemorrhage\u003c/p\u003e \u003cp\u003eaOR, adjusted odds ratio\u003c/p\u003e \u003cp\u003eCI, confidence interval\u003c/p\u003e \u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study was conducted in accordance with the principles of the Declaration of Helsinki. The study used data from a registered clinical trial (ClinicalTrials.gov: NCT05122169; registration date: November 16, 2021). The study protocol was approved by our institutional review board (approval number: 2022\u0026thinsp;\u0026minus;\u0026thinsp;1515). Written informed consent was obtained from all participants prior to enrollment. Data confidentiality and anonymity were strictly maintained.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research was supported by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health \u0026amp; Welfare, Republic of Korea (grant number : RS-2021-KH120178).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYJL and JHC conceptualized the study. YJL performed the methodology and drafted the manuscript. HSW and JSP supervised the study and reviewed the manuscript. All authors contributed to data acquisition and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used for analysis of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u0026lt;WHO guidelines.pdf\u0026gt;.\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaswime S, Buchmann E. A systematic review of maternal near miss and mortality due to postpartum hemorrhage. Int J Gynaecol Obstet. 2017;137(1):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLatt SM, Alderdice F, Elkington M, Awng Shar M, Kurinczuk JJ, Rowe R. Primary postpartum haemorrhage and longer-term physical, psychological, and psychosocial health outcomes for women and their partners in high income countries: A mixed-methods systematic review. PLoS ONE. 2023;18(6):e0274041.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBernasconi M, Eggel-Hort B, Horsch A, Vial Y, Denys A, Quibel T, Baud D. Paternal and maternal long-term psychological outcomes after uterine artery embolization for severe post-partum hemorrhage. Sci Rep. 2021;11(1):13990.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoro MP, Denys A, de Rham M, Baud D. Short \u0026amp; long term adverse outcomes after arterial embolisation for the treatment of postpartum haemorrhage: a systematic review. Eur Radiol. 2017;27(2):749\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAi W, Zeng Y, Ma Y, Liu L, Fan D, Wu S, Zhang Y. Side-effects of carbetocin to prevent postpartum hemorrhage: A systematic review and meta-analysis of randomized controlled trials. Pharmacol Res Perspect. 2021;9(2):e00745.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlbazee E, Sadan M, Alenezi AM, Almutairi AN, Alenezi MM, Almonayea LE. Efficacy and Safety of Carbetocin Versus Misoprostol in Cesarean Section: A Systematic Review and Meta-Analysis. Cureus. 2022;14(12):e32901.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmaral S, Provinciatto H, Gewehr DM, Lombardi RA, D'Souza RS, Terres MT, Pereira EMM, da Silveira CAB, Assis MLM, Pereira LC, et al. Prophylactic strategies for prevention of postpartum haemorrhage in caesarean delivery: a systematic review and Bayesian network meta-analysis of randomised controlled trials. Lancet Glob Health. 2025;13(8):e1415\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCole NM, Kim JJ, Lumbreras-Marquez MI, Fields KG, Mendez-Pino L, Farber MK, Carusi DA, Toledo P, Bateman BT. Second-Line Uterotonics for Uterine Atony: A Randomized Controlled Trial. Obstet Gynecol. 2024;144(6):832\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl-Goly NA, Maged AM, Kamal WM, Hosny O, Turki D, Helmy NM. Carbetocin versus oxytocin in prevention of postpartum hemorrhage after cesarean delivery in high-risk women. A systematic review and meta-analysis. Arch Gynecol Obstet. 2025;312(2):291\u0026ndash;309.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJaffer D, Singh PM, Aslam A, Cahill AG, Palanisamy A, Monks DT. Preventing postpartum hemorrhage after cesarean delivery: a network meta-analysis of available pharmacologic agents. Am J Obstet Gynecol. 2022;226(3):347\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKalafat E, Gokce A, O'Brien P, Benlioglu C, Koc A, Karaaslan O, Khalil A. Efficacy of carbetocin in the prevention of postpartum hemorrhage: a systematic review and Bayesian meta-analysis of randomized trials. J Matern Fetal Neonatal Med. 2021;34(14):2303\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaged AM, El-Goly NA, Turki D, Bassiouny N, El-Demiry N. 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. J Obstet Gynaecol Res. 2025;51(1):e16194.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZorlu U, Elmas B, T\u0026uuml;rker Erg\u0026uuml;n G, Turgay B, Salman \u0026Ouml;zg\u0026uuml; B, Karag\u0026ouml;z \u0026Ccedil;, Kurtaran G. Moraloğlu Tekin \u0026Ouml;: Carbetocin versus Oxytocin-Based Regimens in Macrosomic Births: A Comparative Hemodynamic Perspective. Bratislava Med J. 2025;126(12):3527\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSamimi M, Hosseiniara R, Akbari H, Beyrami D. Carbetocin versus oxytocin with or without tranexamic acid for preventing postpartum hemorrhage in cesarean delivery: a randomized controlled trial. BMC Pregnancy Childbirth. 2026;26(1):183.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGallos ID, Yunas I, Devall AJ, Podesek M, Tobias A, Price MJ, Oladapo OT, Coomarasamy A. Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. Cochrane Database Syst Rev. 2025;4(4):CD011689.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKorb D, Lopez R, Horlin AL, Schmitz T, Borie C, Sibony O. Effectiveness of prophylactic carbetocin versus oxytocin following vaginal delivery for preventing severe postpartum hemorrhage. Int J Gynaecol Obstet. 2023;162(3):889\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu H, Xu X-Y, Gu N, Ye X-D, Wang Z-Q, Hu Y-L, Dai Y-M. Intravenous Administration of Carbetocin Versus Oxytocin for Preventing Postpartum Hemorrhage After Vaginal Delivery in High Risk Women: A Double-blind, Randomized Controlled Trial. Maternal-Fetal Med. 2020;2(2):72\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSu LL, Rauff M, Chan YH, Mohamad Suphan N, Lau TP, Biswas A, Chong YS. Carbetocin versus syntometrine for the third stage of labour following vaginal delivery\u0026ndash;a double-blind randomised controlled trial. BJOG. 2009;116(11):1461\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhigham CA, Gorelik A, Loughnan TE, Trivedi A. Carbetocin versus oxytocin to reduce additional uterotonic use at non-elective caesarean section: a double-blind, randomised trial (). J Matern Fetal Neonatal Med. 2016;29(23):3866\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJin XH, Li D, Li X. Carbetocin vs oxytocin for prevention of postpartum hemorrhage after vaginal delivery: A meta-analysis. Med (Baltim). 2019;98(47):e17911.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan der Nelson H, O'Brien S, Burnard S, Mayer M, Alvarez M, Knowlden J, Winter C, Dailami N, Marques E, Burden C, et al. Intramuscular oxytocin versus Syntometrine((R)) versus carbetocin for prevention of primary postpartum haemorrhage after vaginal birth: a randomised double-blinded clinical trial of effectiveness, side effects and quality of life. BJOG. 2021;128(7):1236\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWidmer M, Piaggio G, Nguyen TMH, Osoti A, Owa OO, Misra S, Coomarasamy A, Abdel-Aleem H, Mallapur AA, Qureshi Z, et al. Heat-Stable Carbetocin versus Oxytocin to Prevent Hemorrhage after Vaginal Birth. N Engl J Med. 2018;379(8):743\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang X, Xue W, Zhou J, Zhou C, Yang F. Effect of Carbetocin on Postpartum Hemorrhage after Vaginal Delivery: A Meta-Analysis. \u003cem\u003eComput Math Methods Med\u003c/em\u003e 2022, 2022:6420738.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcKimmie-Doherty M, Vasilevski V, De Luca L, McDonald E, Grainger T, Nash L, Sweet L. Carbetocin for Postpartum Haemorrhage Prophylaxis in All Births: A Retrospective Cohort Study Following Policy Change in Routine Uterotonic Use. BJOG. 2026;133(2):293\u0026ndash;301.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTai K, Barman K, Das R, Mili T, Chowdhury N. Comparison of intravenous carbetocin versus intramuscular oxytocin in management of third stage of labour in vaginal delivery. New Indian J OBGYN. 2024;10(2):300\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"uterotonic agents, postpartum hemorrhage, carbetocin, vaginal delivery","lastPublishedDoi":"10.21203/rs.3.rs-9069155/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9069155/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTo describe current practice patterns and compare the effectiveness and safety of uterotonic agents for postpartum hemorrhage prevention after vaginal delivery.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective study used data prospectively collected from a multicenter cohort derived from a registered clinical trial (NCT05122169) conducted at nine obstetric centers in South Korea between December 2021 and July 2025. Patterns of uterotonic agent use were described, followed by comparative analyses among women who underwent vaginal delivery. Postpartum hemorrhage\u0026ndash;related outcomes, including hemoglobin decrease by \u0026ge;\u0026thinsp;2 g/dL, blood transfusion, and invasive hemostatic interventions, were compared using unadjusted analyses and multivariable logistic regression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eCarbetocin was the most frequently used uterotonic agent (47.8%) in 2,585 women. Its use as a monotherapy was associated with lower rates of hemoglobin decrease by \u0026ge;\u0026thinsp;2 g/dL compared with oxytocin-only use. In multivariable analyses, carbetocin-only use tended to be associated with lower odds of hemoglobin decrease by \u0026ge;\u0026thinsp;2 g/dL compared with oxytocin-only use, although without statistical significance. The use of carbetocin in combination with additional uterotonic agents was associated with higher odds of hemoglobin decrease by \u0026ge;\u0026thinsp;2 g/dL compared with carbetocin-only use.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study provides a comprehensive analysis of uterotonic agent use in Korean obstetric practice, offering an evidence-based insight into the clinical importance of carbetocin use in vaginal delivery.\u003c/p\u003e","manuscriptTitle":"Comparative Effectiveness of Uterotonic Agents for Postpartum Hemorrhage Prevention after Vaginal Delivery: A Retrospective Analysis of a Multicenter Prospective Cohort in Korea","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-14 20:00:06","doi":"10.21203/rs.3.rs-9069155/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-21T14:18:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"18851093130029231692256247613447549396","date":"2026-04-14T15:57:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-11T07:37:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"254294877569245623996261536271680734722","date":"2026-04-10T04:37:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"229994623206329649756407272072293180573","date":"2026-04-09T15:52:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-07T13:49:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-06T11:41:38+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-16T13:35:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-12T17:51:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-03-12T09:26:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cf8882e3-cb33-424d-b076-bc6d67c9edff","owner":[],"postedDate":"April 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T20:00:06+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-14 20:00:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9069155","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9069155","identity":"rs-9069155","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}