Clinical evaluation of methergine

Abstract

A fairly large series of cases has been studied in an effort to determine the efficacy of Methergine, a newly introduced synthesized oxytocic drug. There were 550 patients who received Methergine, and a control group of 406 patients who were treated according to the current routine of intravenous ergonovine.In both groups, slightly over 80 per cent of the patients were either primigravidas or secundigravidas.The method of delivery of the patients who were given Methergine was spontaneous in 34 per cent of the cases and by low forceps in 61.09 per cent. Various types of breech delivery accounted for 2.18 per cent of the cases. In this study, all cesarean sections were excluded. Delivery of the ergonovine patients was spontaneous in 45.81 per cent of the cases, by low forceps in 50.49 per cent, and either spontaneous delivery or extraction of the breech in 1.97 per cent.Spinal anesthesia was used for 63.27 per cent of the Methergine group, nitrous oxide-oxygen-ether for 23.27 per cent, and ether for 11.27 per cent. There were a few cases delivered under nitrous oxide or local block anesthesia. Only 41.62 per cent of the ergonovine patients were delivered under spinal anesthesia, while the incidence of nitrous oxide-oxygen-ether was more than double that of the Methergine group, 56.41 per cent of the patients receiving this type of anesthetic. Ether was rarely used in this group, being employed in only 0.98 per cent of the cases.When Methergine was used, the first contraction of the uterus occurred within two minutes or less from the time the drug was injected in 89.63 per cent of the cases. For ergonovine, the percentage was 94.82 per cent. The time from injection to the end of the third stage was 5 minutes or less in 87.27 per cent of the patients given Methergine, and in 80.54 per cent of the patients given ergonovine. Manual removal of the placenta was performed on 0.72 per cent of the patients who were given Methergine as compared to 0.49 per cent of the ergonovine patients. The total number of manual removals, four for Methergine and two for ergonovine, is so small that any statistical importance is questioned.Blood loss was considered in four categories: preplacental, placental, postplacental, and total. Preplacental blood loss with Methergine ranged from a minimum of 0 c.c. to a maximum of 150 c.c. with an average loss of 26 c.c. One hundred cubic centimeters or less was lost in 98.9 per cent of the cases. With ergonovine, the minimum loss was 0 c.c., the maximum 150 c.c., the average loss 30 c.c. and 97.75 per cent of the patients lost 100 c.c. or less.With Methergine, the minimum placental blood loss was 0 c.c. The maximum loss was 1,200 c.c., in a case of partial separation of the placenta. All of the others had a loss of 250 c.c. or less, with an average of 58 c.c., and 99 per cent had a loss of 150 c.c. or less. Minimum loss with ergonovine was 0 c.c., maximum was 250 c.c., average loss was 62 c.c., and 98.3 per cent lost 150 c.c. or less.Postplacental blood loss with Methergine varied from a minimum of 0 c.c. to a maximum of 500 c.c. The average loss was 56 c.c. with 98 per cent losing 200 c.c. or less. With ergonovine the minimum loss was also 0 c.c., the maximum was 400 c.c., the average loss was 62 c.c., and 98.7 per cent lost 200 c.c. or less.Minimum total blood loss with Methergine was 25 c.c. The patient who had a placental blood loss of 1,200 c.c. lost a total of 2,000 c.c. Of the other cases, the total loss was 600 c.c. or less. Average loss for all cases was 149 c.c., with 98 per cent of patients losing 200 c.c. or less. With ergonovine the minimum loss was 50 c.c. and the maximum was 500 c.c. The average loss was 146 c.c., with 99.2 per cent of patients losing 200 c.c. or less.