Postpartum Severe Sinus Bradycardia following Methylergonovine Administration

Abstract

The case is reported of a 30-year-old multigravida, with insignificant history and stable vital signs, admitted to the labour room for normal vaginal delivery of twins. She received combined spinal epidural analgesia (bupivacaine plus fentanyl) for 3 h. Following uneventful delivery she received 0.2 mg methylergonovine maleate, intramuscularly. Nausea and vomiting occurred 70 min after placenta delivery, heart rate decreased, arterial blood pressure increased and there was chest pain. After excluding cardiac ischaemia, 0.5 mg atropine sulphate was administered intravenously. Chest pain improved but heart rate and blood pressure increased more than expected. The patient had mild headache and nausea, and antiemetic 4 mg ondansetron was given intravenously. Continuous monitoring for 4 h showed spontaneous chest pain relief and blood pressure improvement. In conclusion, serious delayed side-effects arising from methylergonovine maleate can occur in young, normal patients and close monitoring is required. Intravenous atropine sulphate following methylergonovine maleate administration may lead to severe hypertension and tachycardia.

Randomized controlled trial of tranexamic acid among parturients at increased risk for postpartum hemorrhage undergoing cesarean delivery

“…The most common etiology for PPH is uterine atony, which responds to uterotonic drugs, including oxytocin, methylergometrine, and prostaglandins [3]. However, several adverse effects are associated with these drugs [3–6], and oxytocin‐receptor downregulation and desensitization following exposure to oxytocin leads to a lack of further improvement in uterine contractions irrespective of dose increases [7]. Oxytocin‐induced desensitization is dependent on the duration of oxytocin exposure and occurs over a clinically relevant time frame of 4.2 h [4].…”

Postpartum Transient Hypervagotonic Sinus Node Dysfunction Leading to Sinus Bradycardia: A Case Report

“…The cause remains unclear but the anatomic variation of the vagus nerve or the change in sensitivity of afferent nerve endings and medulla oblongata due to chronic VNS has been attributed [11]. Methylergonovine, an ergot alkaloid, used to control postpartum hemorrhage has also been reported to cause late-onset sinus bradycardia [12]. However, our patient didn't have any of the abovementioned risk factors to explain the phenomena.…”

Post-partum maternal bradycardia: A case series and literature review

“…It was noted that if bradycardia was presumed secondary to anesthesia it would resolve within hours. The most common etiologies described by the authors for maternal bradycardia was medications, [8][9][10][11][12] primary conduction abnormalities, 5,13,14 preeclampsia, 15,16 anesthesia, 17 and peripartum cardiomyopathy. 18 Two case reports did not identify a clear cause for the patient's bradycardia.…”