Administration of methylergonovine during intrapartum cesarean section, instead of after cesarean delivery, can reduce the risk of PPH, according to a new study by researchers from the University of Iowa Hospitals, Iowa City, USA, which was presented at the 2022 virtual Pregnancy Meeting of the Society of Maternal-Fetal Medicine on Friday and also published in the American Journal of Obstetrics & Gynecology.

This single center study was conducted between June 2019 and February 2021 and comprised 160 women in labor who underwent an intrapartum cesarean birth. They were randomly assigned to two treatment groups of 80 each, one which was administered only IV oxytocin (300 mU/minute) and the other which was also given IM methylergonovine (0.2 mg) in combination with IV oxytocin.

Very few other uterotonic agents were needed in women who also received prophylactic methylergonovine, compared to women who were treated with oxytocin alone; 20% vs 55%, respectively with a relative risk of 0.36. Results also showed better uterine tone (80% vs 41.2%, RR 1.94), lower mean quantitative blood loss (996 ml vs 1315 ml) and decreased need for a blood transfusion (5% vs 22.5%, RR 0.22) in the methylergonovine group. The incidence of PPH was also considerably lower in this group of patients (35% vs 58.8%, RR 0.6).

This study indicates that prophylactic methylergonovine together with oxytocin in women undergoing an intrapartum cesarean section decreased the need for additional uterotonic agents. Uterine atony is a major cause of PPH, which can be potentially life-threatening. By decreasing the risk of PPH and need for blood transfusions, the associated morbidity as well as adverse reactions to blood transfusion or transfusion Transmissible Infections (TTI) were also reduced. However, it is important to note here that the use of methylergonovine is contraindicated in women with hypertension, eclampsia/pre-eclampsia, mitral valve prolapse, history of coronary artery disease and liver disease. Hence, the careful selection of the right patient is important.

Reference

1. Masse N, et al. A randomized controlled trial to assess prophylactic methylergonovine in patients undergoing an intrapartum cesarean section. Am J Obstet Gynecol. 2022 Jan. 1;226(1 Suppl):S34. DOI:https://doi.org/10.1016/j.ajog.2021.11.046.