As the number of cesarean sections increases, does the combined use of oxytocin and methylergonovine during the procedure affect postpartum hemorrhage?

Abstract

In this study, we sought to demonstrate the benefit of postpartum hemorrhage prophylaxis treatment and the superiority of methylergonovine-oxytocin combination over oxytocin in terms of hemodynamic stability and amount of bleeding during cesarean section. In this retrospective study, 400 patients who had a cesarean section in the same clinic were divided into two groups and included in this study. The first group consisted of nulliparous patients (n=141) who gave birth by cesarean for the first time and the second group consisted of multipar patients (n=259) who gave birth by cesarean section before. Then both main groups; women who received only oxytocin infusion in the intraoperative and postoperative periods were divided into (monotherapy group), women who received methylergonovine and oxytocin therapy in the intraoperative and postoperative periods were divided into 2 more subgroups (combined group). For comparison, samples for preoperative and postoperative complete blood counts were obtained from all patients in each group. When the postoperative Hb levels of nulliparous pregnant women were compared, it was seen that the decrease in Hb levels was less in the group that received methylergonovine in addition to oxytocin (p=0.031). Similarly, Hb decrease was observed less in the group given methylergonovine in addition to oxytocin in multiparous pregnant women (p=0.045). The group that received methylergonovine in addition to oxytocin provided more hemodynamic stability in both the nulliparous and multiparous cesarean section groups, which we divided according to the number of cesarean sections, compared to the group that received oxytocin; significantly reduced the level of bleeding. We think that this form of treatment will also reduce the risk of uterine atony; therefore (if there is no coronary disease) we recommend it to be used under spinal anaesthesia.