| Summary: | Post-partum hemorrhage (PPH) is generally defined as bleeding in excess of 500 ml after a vaginal birth or 1000 ml after a Cesarean section in Canada. In clinical practice, PPH should be considered when signs of hypovolemic shock or hemodynamic instability are present. There are risk factors associated with the occurrence of PPH, including retained placenta, coagulopathy, and vaginal injury. Placenta retention and hemostasis are affected by myometrial contractions. Prophylactic use of uterotonics is the standard of care globally. Two uterotonics, oxytocin and carbetocin are in the Essential Medicines List by the World Health Organization. Oxytocin works on receptors of smooth muscle and stimulate the upper uterine to contract regularly. Carbetocin is a long-acting synthetic oxytocin analogue and also works by stimulating the uterus. There are adverse effects common to both drugs, such as nausea and vomiting. One advantage of carbetocin is its tolerance to heat and does not require cold-chain transport and storage that is needed for oxytocin use. There are studies showing similar or superior effectiveness of carbetocin for the prevention of PPH, when compared to oxytocin. However, the use of carbetocin has not been popular in Canada. There is a need to review the clinical effectiveness, cost-effectiveness, and clinical guidelines to understand the potential role of carbetocin in Canada
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