Intravenous Versus Intramuscular Administration of Methylergonovine for Uterine Contraction in Cesarean Sections
Status:
Withdrawn
Trial end date:
2020-12-01
Target enrollment:
Participant gender:
Summary
Insufficient uterine tone resulting in atony can potentiate hemorrhage and adverse outcomes
for the parturient. Oxytocin is the first pharmacologic agent used, followed by
methylergonovine, carboprost, and misoprostol. The American Congress of Obstetricians and
Gynecologists (ACOG) recommends the sequential use of oxytocin, followed by methylergonovine,
carboprost, misoprostol, then surgical intervention for cases of refractory uterine atony.
Many studies have examined the effect and dosage of intravenous uterotonics, including
oxytocin.
Although there are anecdotal reports of using intravenous bolus or rapid infusion of
methylergonovine, no randomized trial has compared efficacy and side effects of these two
routes of administration. Investigators hypothesize that intravenous methylergonovine reduces
the time to adequate uterine tone (the tone at which the uterus is adequately contracted to
prevent atony after delivery of neonate), decreases the total dose of methylergonovine to
contract the uterus, and therefore produces fewer side effects of hypertension, nausea, and
vomiting. Reducing the time to achieve adequate uterine tone is likely to decrease postpartum
hemorrhage.