RCT Results: Does Adding Methylergonovine to Oxytocin Reduce the Need for Additional Uterotonics Following Intrapartum Cesarean Delivery?
BACKGROUND AND PURPOSE:
Masse et al. (Obstetrics and Gynecology, 2022) evaluated whether the administration of prophylactic methylergonovine in addition to oxytocin in patients undergoing intrapartum cesarean birth reduces the need for additional uterotonic agents
Study group: Intervention: IV oxytocin (300 mL/minute) and IM methylergonovine 0.2 mg (1 mL)
Control: IV oxytocin (300 mL/minute) and IM saline (1 mL)
Sample size of 76 patients per group
Goal to detect a twofold decrease in the need for additional uterotonic agents based upon a 42% baseline
80% power | Two-sided type 1 error of 5%
Receipt of additional uterotonic agents
Surgeon assessment of uterine tone
Incidence of postpartum hemorrhage (>1 L within the first 24 hours postpartum)
Quantitative blood loss
Intervention: 80 patients | Control: 80 patients
Significantly fewer patients who were allocated to the methylergonovine group received additional uterotonic agents
Relative risk (RR) 0.4 (95% CI, 0.2 to 0.6)
Participants receiving methylergonovine were also more likely to have
Satisfactory uterine tone
RR 1.9 (95% CI, 1.5 to 2.6)
Lower incidence of postpartum hemorrhage
RR 0.6 (95% CI, 0.4 to 0.9)
Lower mean quantitative blood loss
Intervention: 967 mL
Control: 1315 mL
Mean difference 348 (95% CI, 124 to 572)
Lower frequency of blood transfusion
RR 0.2 (95% CI, 0.1 to 0.6)
In the setting of intrapartum cesarean delivery, adding prophylactic methylergonovine to oxytocin significantly reduced the need for additional uterotonic agents
The authors state
Prior studies have noted oxytocin resistance in laboring patients undergoing intrapartum cesarean birth
Continuous exposure of human myometrial cells to oxytocin leads to a loss in their capacity to respond to oxytocin
The administration of prophylactic methylergonovine in patients requiring intrapartum cesarean birth could therefore serve to improve uterine tone and decrease postpartum hemorrhage by facilitating uterine contraction through an alternative, non–oxytocin receptor–dependent pathway
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