The Effect of the Combined Use of Methylergonovine and Oxytocin during Caesarean Section in the Prevention of Post‐partum Haemorrhage

Abstract

We aimed to show to patients the benefit of post-partum haemorrhage prophylaxis treatment and the effectiveness as a uterotonic agent of the combined use of methylergonovine and oxytocin infusion in the prevention of haemorrhage during and after Caesarean section, by comparison with a control group which received oxytocin infusion only. Two groups of patients undergoing Caesarean section at the same clinic were included in the study. A combination of methylergonovine and oxytocin was administered to the first group during the intra-operative and post-operative periods. The second group did not receive methylergonovine and was administered only with oxytocin infusion in the intra-operative and post-operative periods. Pre-operative and post-operative haemogram readings were taken for all patients in each of the groups for comparison. No difference was found between the two groups with regard to mean ages and pre-operative haemogram values. The decrease in post-operative haemoglobin values for the group administered with methylergonovine maleate and oxytocin was found to be significantly greater than for the group administered with oxytocin only. Results indicated that prophylactic methylergonovine treatment was clearly successful for the patients and no adverse side effects were found. The routine use of methylergonovine and oxytocin infusion in combination during the intra-operative period of Caesarean section reduced the level of post-partum haemorrhage considerably. We believe that this procedure will also reduce the risk of uterine atony, but clearly, prospective studies will be necessary in future to confirm this assumption.In recent years, there has been a marked increase in the number of Caesarean sections carried out. This can be attributed largely to the rise in the rate of primary elective Caesarean section. In turn, this has led to a higher frequency of placenta previa, uterine atony and post-partum haemorrhage.The increased prevalence of post-partum haemorrhage across the world is of particular concern as it is widely recognized as a major contributor to maternal mortality. Studies have estimated that post-partum haemorrhage might account for as much as 30% of maternal mortality and its incidence all over the world ranged from 2 to 11% of all childbirths [1,2]. The frequency of post-partum haemorrhage was found to be higher in underdeveloped regions such as Africa, Asia and Latin America [3]. The currently accepted definition is to consider post-partum haemorrhage as blood loss of more than 500 mL whatever the type of delivery and severity as blood loss beyond 1000 mL [4]. The American College of Obstetricians and Gynaecologists adjudged that a decrease in haematocrit at a rate of 10% or more constituted post-partum haemorrhage [5].Although haemoglobin and haematocrit levels are valuable diagnostic tools in identifying haemorrhage, they can be misleading in the determination of acute bleeding. Therefore, follow-up of a patient's vital signs, together with checks of haemoglobin and haematocrit...

A randomised controlled study for the prevention of post-partum haemorrhage with oxytocin plus methyl ergometrine versus oxytocin alone in the third stage of labour

“…The difference in pre and post natal haemoglobin was 0.85 in the combined methyl ergometrine+oxytocin group and 1.05 in the oxytocin only group which was statistically significant, thus indicating that the blood loss was significantly lesser in the combined group. 13 According to the Cochrane Review 2018, ergometrine plus oxytocin combination, carbetocin, and misoprostol plus oxytocin combination were more effective for preventing PPH ≥500 ml than the current standard oxytocin. Ergometrine plus oxytocin combination was more effective for preventing PPH ≥1000 ml than oxytocin.…”

Epidemiology, prevention and management of early postpartum hemorrhage — a systematic review

“…A combination of methylergonovine and oxytocin infusion during CS successfully decreased severity of EPH [22]. On the other hand a combination of misoprostol and oxytocin seemed to increase the risk of side effects related to pharmacotherapy, such as fever, nausea and shivering.…”

Análise das intervenções utilizadas na prevenção e controle da hemorragia pós-parto: revisão integrativa da literatura

“…Os quatorze estudos fizeram caracterização clínica das intervenções, conforme mostra o quadro 4. Todos os estudos descreveram o tipo de parto onde ocorreu a intervenção no manejo da hemorragia pós-parto, sendo prevalente o parto vaginal (Rangel et al, 2019;Begley et al, 2019;Salati et al, 2019;Asmat et al, 2017;Quibel et al, 2016;Suarez et al, 2020;Escobar et al, 2020;Şentürk et al, 2016;Sanad et al, 2018;Gallos et al, 2018;Woman et al, 2017;Anger et al, 2019;Maged et al, 2019;Amornpetchakul et al, 2018).…”

“…Quanto a perda sanguínea das puérperas na hemorragia pós-parto, os seguintes estudos mostraram que o volume variou de ≥500 a ≥2000mL (Begley et al, 2019;Salati et al, 2019;Asmat et al, 2017;Quibel et al, 2016;Suarez et al, 2020;Escobar et al, 2020;Şentürk et al, 2016;Sanad et al, 2018;Gallos et al, 2018;Woman et al, 2017;Maged et al, 2019;Amornpetchakul et al, 2018).…”

“…Um número relativamente pequeno de estudos realizou caracterização sociodemográfica, nos estudos que avaliaram, a faixa etária variou de 18 a 44 anos (Asmat et al, 2017;Şentürk et al, 2016;Sanad et al, 2018;Woman et al, 2017;Anger et al, 2019;Maged et al, 2019;Amornpetchakul et al, 2018).…”