Methylergometrine Research Articles

Novel Electrochemical Sensor Based on Polydopamine Molecularly Imprinted Polymer for Selective Determination of Methylergonovine Maleate

Novel Electrochemical Sensor Based on Polydopamine Molecularly Imprinted Polymer for Selective Determination of Methylergonovine Maleate

TO ESTIMATE THE INCIDENCE OF INTRAOPERATIVE NAUSEA AND VOMITING AND ITS ASSOCIATION WITH CAUSATIVE FACTORS IN LSCS UNDER SPINAL ANAESTHESIA

Introduction: Spinal anaesthesia is the injection of local anaesthetic into the subarachnoid space and is anaesthesia of choice for LSCS. Associated hypotension, uterotonic drugs, level of spinal anaesthesia, are the main cause of intraoperative nausea and vomiting which could lead to patient discomfort and protrusion of the abdominal viscera that disturbs the surgical procedure. [4] To study the incidence of intraoperative nausea and vomiting among the pati Objectives- ents undergoing LSCS under spinal anesthesia and its association with causative factors. Material and methods: The cross-sectional observational study was performed for the duration of 18 months at Dr. D. Y. Patil medical college hospital, and research Institute, Kolhapur from April 2021 to September 2022 after explaining the study and taking written consent from the participants. In this study, we use a 40% proportion to calculate the sample size and included 368 consecutive parturients, operated during the study period. The average age of t Result: he participant was 24.98±4.076 years ranging from 19 to 40 years. The signicant ndings of the study were the incidence of IONV was found to be 24.18%. Among the included subjects,25.8%(n=95) of the patients had a history of LSCS. Previous history of IONV was present in 19.6% (n=72) participants. IOH was noted in 41.6% (n=153) of patients whereas it was absent in 58.4%(n= 215) of subjects. The incidences of IONV were found to be present in 17.02%, 62.5%, and 44.64% of the patients who were administered with only oxytocin, oxytocin + carboprost, and oxytocin + methyl ergometrine as a Uterotonic respectively. In n=23 subjects, the level of anaesthesia was T5, among these subjects n=18 subjects had IONV.Out of 344 subjects with T6 anaesthesia level, n=70 subjects had IONV. A subject with a T7/8 level of anaesthesia had IONV. There was 24.18% Conclusionincidence of IONV among 368 subjects. IONV was signicantly associated with the previous history of IONV and predictive factors, IOH, type of UTs used, and level of anaesthesia

UTEROTONIC USE IN THE ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL): SYSTEMATIC REVIEW

<p><strong>Background:</strong> Maternal mortality rate in Indonesia has decreased from 184/100,000 live birth (LB) (2016) to 177/100,000 LB (2017), but this number is still high enough than SDGs target of 70/100,000 LB. The one of direct cause of maternal death is hemorrhage, especially postpartum hemorrhage (PPH). Causes of PPH are uterine atony, laceration of birth canal, resistant placenta and uterine inversion. PPH prevention method is Active Management of Third Stage of Labor (AMTSL). The objective of this systematic review is to analyze the use of uterotonics in AMTSL.</p><p><strong>Methods:</strong> This systematic review used the PRISMA protocol, articles taken from Google Scholar, Science Direct, and Pub Med. The time span of the research article was 2010 to 2021.</p><p><strong>Result:</strong> The results of the study describe that the use of uterotonics in single use or combination in third stage of labor can reduce the risk of PPH and shorten the time of the stage. The side effects were reported in misoprostol and methyl ergometrine than oxytocin. In addition, combination therapy with oxytocin and misoprostol can reduce the length of the third stage and the potential for a decrease in hemoglobin within 24 hours of delivery. In Indonesia, if oxytocin is not available, maternal nipple stimulation is performed as nonpharmacological therapy or ergometrine 0.2 mg is given to patients without complications of high blood pressure.</p><p><strong>Conclusion:</strong> The use of uterotonics is adjusted to its cost-effectiveness, ability to store and refrigerate also the benefits compare to the side effects to the patients.</p>

Methylergometrine

Methylergometrine

Intra-umbilical Oxytocin versus Methyl Ergometrine in the Third Stage of Labor: A Comparative Study from an Egyptian Tertiary Care Hospital

AbstractRecently, the active management of the third stage of labor hasbecome a routine practice. In this study we compared two different ecobolics which were oxytocin and methyl ergometrinethrough intra-umbilical route. The method: the trial divided theincluded pregnant full term (>37 weeks) women in two groupsrandomly; one for 0.2 mg methyl ergometrine and the second 10units oxytocin. The outcomes were on the short term; estimatedblood loss (EBL), the need to add another ecobolic, vomiting,blood pressure changes and the duration of the third stage, andthe long-term outcomes were hemoglobin levels and the needfor surgical or medical uterine evacuation. The results: the meanblood loss was 155± 50.45ml and 167± 45.76 in the methyl ergometrine and the oxytocin groups respectively. Three cases inthe oxytocin group (3%) required additional methyl ergometrinewhile in the ergometrine group only one case was given an additional oxytocin (1%). No vomiting was reported in both groupsand there were trivial changes in blood pressure. In the oxytocin group, the third stage duration was average 3.03± 1.02 minin comparison to 2.98± 1.54min in the ergometrine group. Neither did those cases who were injected methyl ergometrine havesignificant changes in the hemoglobin levels nor did they needuterine evacuation. However, only one case in the oxytocin siderequired blood transfusion due to uterine atony. Conclusion: intra-umbilical methyl ergometrine should be considered as an effective safe ecobolic in the third stage of labor.

Methylergometrine

Methylergometrine

CARBETOCIN VERSUS COMBINED OXYTOCIN AND METHERGINE FOR PREVENTION OF POSTPARTUM HEMORRHAGE AFTER VAGINAL DELIVERY IN HIGH RISK PREGNANCY

Background: Around the world, one woman every minute dies as a result of postpartum hemorrhage (PPH) and it remains the single major cause of maternal mortality and morbidity. The early identification of risk factors and effective prevention and management of PPH are critical to minimize the impact of PPH. Carbetocin, a new drug for the prevention of uterine atony, is a synthetic analogue of oxytocin with a half-life of up to 4 to 10 times longer than that of oxytocin. In comparison with oxytocin, it is used as a single-dose injection instead of an infusion and can be given intravenously or intramuscularly. Objective: To evaluate the effect of carbetocin in preventing postpartum hemorrhage after vaginal delivery in comparison with combined oxytocin and methergine. Patients and methods: This study was conducted at Al-Galaa Maternity Hospital during the period from 1 June to 1 December 2020. The study included 100 candidates between 37 to 40 weeks with a risk factor to develop PPH divided randomly into two equal groups: Group A received a single 100 mg IM dose of carbetocin (Pabal®) and Group B received 5 IU IM oxytocin (Syntocinon®) combined with 1 mL, 0.2 mg IM methylergonovine maleate (Methergine®). Results: Carbetocin was more effective, with significant difference, in reducing the time of 3rd stage of labor, reducing amount of blood loss and drop of both HB% and hematocrit levels with significant decreased incidence of side effects. Conclusion: A single 100 mg IM dose of carbetocin (Pabal®) may be more effective as compared to 5 IU IM oxytocin (Syntocinon®) combined with 1 mL, 0.2 mg IM methylergonovine maleate (Methergine®) in reducing postpartum blood loss with a smaller drop in hemoglobin levels.

SUBLINGUAL MISOPROSTOL FOR PREVENTION OF POSTPARTUM HAEMORRHAGE – A RANDOMISED CONTROL TRIAL

Aim – The aim of the study was to study the effect of sublingual misoprostol for prevention of PPH. Materials and Methods – This was a prospective, randomized, double blind, placebo controlled study. Inclusion criteria were women aged 20-40 years with 38-40 weeks of gestation who underwent elective caesarean section. Exclusion criteria were women have risk factors for post-partum haemorrhage, active thromboembolic disease and intrinsic risk for thrombosis. Participants were randomly assigned to misoprostol group or group A (n=50) and placebo group or group B(n=50). Group A received 400µg of sublingual misoprostol after delivery of the baby, group B received placebo tablet at the same time. Primary outcome measures were blood loss from delivery of the placenta to the end of the caesarean section to 2 hours postpartum, haemoglobin estimation was done in all patients pre operatively and 24 hours post operatively and the change in concentration was noted. Secondary outcome measures were need for additional uterotonics, use of additional surgical interventions to control post-partum haemorrhage. Result – Blood loss from both placental delivery to the end of caesarean section and from end of caesarean section to 2 hours postpartum were signicantly lower in the study group. (p<0.0001). Change ifn haemoglobin concentration in study group was also signicantly less than in the control group. (p<0.0001). Total amount of Oxytocin required was signicantly less in the study group (p=0.01). The number of women requiring other oxytocics (inj. Methyl ergometrine, inj. Carboprost) was signicantly less in study group (p=0.0078). Conclusion – Sublingual misoprostol has been found to be effective in preventing PPH.

A comparative study of efficacy of rectal misoprostol with intravenous methyl ergometrine and intramuscular PGF2a in active management of third stage of labor

PPH is almost entirely a preventable condition when management is based on scientifically proven methods. It occurs in approximately 4% of vaginal deliveries, and estimates are that it causes significant morbidity and 25% of all the maternal child birth related deaths. We conducted this study with the following aims to compare the effectiveness of rectal misoprostol (600mcg) with intravenous methylergometrine (0.2mg) and intramuscular PGF2α (125mcg). To find out the percentage of pregnant women having postpartum hemorrhage, amount of blood loss and efficacy and safety of uterotonic drugs during third stage of labor. Patients with full-term singleton pregnancy in the age group of 20-35 years admitted in the maternity ward for vaginal delivery were enrolled in the study after taking written informed consent. The third stage of labor was actively managed in these patients by either 600mcg of misoprostol per rectally (Group A) or 0.2mg of IV methylergometrine (Group B) or 125mcg of PGF2α intramuscularly (Group C) and some were given any prophylactic oxytocic (Group D). Majority 110 (55%) of the studies participants were in the age group of 20-24 years. Moreover, 109 (54.5%) belonged to upper middle (II) socioeconomic class as per modified Kuppuswamy’s socioeconomic scale update for 2018. Only, 7 (3.5%) of the participants were grand multipara’s while 24 (12%) had gestational age greater than 40 weeks. Mean maternal age, gestational age and duration of third stage of labor was comparable in all the study groups. Maximum amount of blood loss was seen among participants who were in control group (201.80 ± 122.81 ml) and the maximum ‘mean difference in Hb’ was also seen in control group (0.83 gm%). Reported side effects during the study included diarrhea, nausea, shivering and vomiting in (1.5%) participants. Postpartum hemorrhage and retained placenta was reported among 7 (3.5%) and 2 (1%) participants only.Misoprostol can be used as a safe and effective alternative agent in active management of third stage of labor.

A randomized controlled trial of methylergonovine prophylaxis after dilation and evacuation abortion

ObjectiveTo evaluate the efficacy of intramuscular methylergonovine maleate as prophylaxis against excessive bleeding when given after dilation and evacuation (D&E) at 20–24 weeks. Study designWe performed a randomized, double-blinded, placebo-controlled trial in patients without excessive bleeding requiring intervention after D&E completion. We administered study treatment within one minute of the end of the procedure. We primarily compared outcomes using a composite of indicators of excessive post-procedure blood loss (post-procedure measured blood loss exceeding 125 mL, uterine massage or compression for at least two minutes, administration of additional uterotonic medication, intrauterine balloon tamponade, uterine re-aspiration, blood transfusion, uterine artery embolization, hospital admission for bleeding, or major surgery). Secondary outcomes included individual indicator occurrences, satisfaction, and side effects. ResultsFrom March 3, 2015 to March 31, 2017, we randomized 284 participants (n = 140 methylergonovine, n = 144 placebo), five before we registered the trial with clinicaltrials.gov. Baseline characteristics were similar between groups. The composite outcome occurred in 78 (56%) methylergonovine and 75 (52%) placebo participants (p = 0.5). Methylergonovine recipients required more intrauterine balloon use (n = 20 [14%]) versus placebo (n = 10 [7%]), p = 0.04. We also observed a non-significant trend towards more uterotonic administration (n = 56 [40%] versus n = 43 [30%], p = 0.07) and hospital admissions for bleeding (n = 4 [3%] versus n = 0, p = 0.06) in the methylergonovine group compared to placebo. ConclusionWe observed no improvement in the composite outcome for excessive bleeding with prophylactic post-procedure methylergonovine. In addition, individual excessive bleeding outcomes occurred more frequently in the methylergonovine group, potentially indicating harm with its prophylactic use after D&E. ImplicationsWhen administered prophylactically immediately after dilation and evacuation abortion at 20–24 weeks, methylergonovine increases uterine bleeding. Given the lack of data for effectiveness as a prophylactic agent and our findings indicating harm, we do not recommend its use for post-operative prophylaxis.

Maternal Fetal Health

Maternal Fetal Health

Comparison of Low Dose versus High Dose of Oxytocin for Initiating Uterine Contraction During Cesarean Delivery: A Randomized, Controlled, Non-Inferiority Trial.

BackgroundOxytocin is used for initiating uterine contraction and preventing postpartum hemorrhage during caesarean delivery. Using a lower dosage of oxytocin may lower the risk of adverse effects while still being effective in stimulating initial uterine contraction. We aimed to compare the effectiveness and side effects of the standard 10 IU bolus of oxytocin with those of a 5 IU bolus during caesarean delivery.Patients and MethodsWe enrolled women in a randomized, double-blind, study comparing intravenous injections of high-dose (10 IU) and low-dose (5 IU) oxytocin administered after clamping of the umbilical cord. The primary outcome was adequate uterine contraction within the first 3 mins after administration. Secondary outcomes included uterine tone, use of additional uterotonic agents, additional obstetrics procedures, and oxytocin-related adverse events.ResultsA total of 155 women underwent randomization, with 78 in the low-dose group and 77 in the high-dose group. The proportion of women with adequate uterine contraction during the first 3 mins was 84.6% in the low-dose group and 77.9% in the high-dose group (relative risk, 1.09; 95% CI, 0.93 to 1.26). Methylergonovine maleate was used in 14.1% of cases in the low-dose group and 36.4% in the high-dose group (relative risk, 0.40; 95% CI, 0.22 to 0.73). The necessity for additional obstetric procedures, estimated blood loss >500 mL, neonatal outcomes, and oxytocin-related adverse effects did not differ significantly between the two groups.ConclusionThe 5 IU bolus of oxytocin was noninferior to the standard 10 IU bolus of oxytocin for initiating adequate uterine contraction, required fewer additional uterotonic agents, and led to fewer oxytocin-related adverse events.

Prophylactic use of Tranexamic Acid during Caesarean Section in Preventing Postpartum haemorrhage– a Prospective Randomised Double Blind Placebo Controlled Study

Background: Postpartum haemorrhage (PPH) is a major cause of maternal mortality,accounting for one-quarter of all maternal deaths worldwide. Tranexamic acid (TXA), anantifibrinolytic agent, has therefore been investigated as a potentially useful complement toprevention and treatment of PPH. It has been proved to reduce blood loss in elective surgery,bleeding in trauma patients, and menstrual blood loss.
 Aims: To evaluate the effectiveness of TXA in reducing blood loss given just immediatelyafter delivery of baby in women undergoing cesarean section.
 Methods: This was a prospective, randomized, double blind, placebo controlled studyconducted in the Department of Gynaecology and Obstetrics unit of IBN SINA Medical CollegeDhaka, Bangladesh from June 2016 to May 2017. Participants were randomly assigned toTXA group or group A (n=60) and placebo group or group B (n=60). Randomization wasdone by residents using computer generated random numbers. Group A received 1 gram(10ml) of intravenous bolus dose of TXA just after delivery of the baby, Group B received 10ml of sterile distilled water for injection intravenously at the same time. Statistical analysishas been done by SPSS.
 Results: The subjective characteristics in the two groups were similar with respect to theirage, BMI, gestational age and gravidity. The duration of surgery was 40-50 minutes. Therewas no statistically significant difference in the heart rates (p>0.05) and blood pressuresbetween the two groups, after 2 hours of delivery. Blood losses from both placental deliveriesto the end of cesarean section and from end of CS to 2 hours postpartum were significantlylower in the study group (p<0.05). Change in hemoglobin concentration in study group wasalso significantly less than in the control group. Total amount of oxytocin required wassignificantly less in TXA group (p<0.05) also the number of women requiring other oxytocics(inj. Methyl ergometrine, inj carboprost and tab misoprostol per rectally) was significantlyless in TXA group (p< 0.05). The amount of intra-operative fluid required were significantlyless in TXA group (p<0.005); however post – operative fluid requirement and minor sideeffects in the form of nausea and vomiting were similar in both the groups.
 Conclusion: Tranexamic acid can effectively reduce blood loss in patients undergoing LSCSand its use was not associated with any side effects and or complications like thrombosis.The adoption of WHO guidelines for using uterotonic agents and prophylactically administeringTXA may significantly reduce the number of PPH incidents.
 Bangladesh J Obstet Gynaecol, 2018; Vol. 33(2) : 125-130

Mild Thrombocytopenia and Postpartum Hemorrhage in Nulliparous Women With Term, Singleton, Vertex Deliveries.

To assess whether mild thrombocytopenia (platelet count 100-149 k/microliter) is associated with an increased risk of postpartum hemorrhage. Nulliparous women with term, singleton, vertex pregnancies undergoing labor at our institution between August 2016 and September 2017 were included. The primary exposure was mild thrombocytopenia, defined as platelet count 100-149 k/microliter, and the comparator was normal platelet count (150 k/microliter or greater). Those with severe thrombocytopenia (platelet count less than 100 k/microliter) were excluded from analysis. The primary outcome was postpartum hemorrhage, determined by International Classification of Diseases, Tenth Revision codes and the hospital discharge problem list. Secondary outcomes included use of uterotonic agents (methylergonovine maleate or carboprost tromethamine), total blood loss 1,000 mL or greater, and blood transfusion. Data were analyzed by t test, χ or Fisher exact test, and multivariable logistic regression, with significance at α <0.05. We evaluated 2,845 eligible women, of whom 2,579 (90.2%) had normal platelet count 150 k/microliter or greater, 266 (9.3%) had platelet count 100-149 k/microliter (mild thrombocytopenia), and 13 (0.5%) had platelet count less than 100 k/microliter (severe thrombocytopenia). Compared with women with normal platelet count, those with mild thrombocytopenia had a higher rate of postpartum hemorrhage (16.9% vs 8.5%, P<.001) and were more likely to have total blood loss 1,000 mL or greater (4.5% vs 1.7%, P=.002) and receive methylergonovine maleate (10.5% vs 5.9%, P=.003) or carboprost tromethamine (6.0% vs 1.6%, P<.001) or both (3.8% vs 1.0%, P<.001), but rates of blood transfusion were no different (1.9% vs 1.5%, P=.59). The association between mild thrombocytopenia and postpartum hemorrhage persisted after multivariable adjustment for potential confounders (adjusted odds ratio 2.2, 95% CI 1.5-3.2, P<.001). Among nulliparous women with term, singleton, vertex pregnancies undergoing labor, those with mild thrombocytopenia (platelet count 100-149 k/microliter) had a twofold greater likelihood of postpartum hemorrhage compared with those with normal platelet count.

To study the efficacy of misoprostol compared with methyl ergometrine for prevention of postpartum haemorrhage

To study the efficacy of misoprostol compared with methyl ergometrine for prevention of postpartum haemorrhage

Short Term Oral Methylergonovine Maleate Prophylaxis for Status Migrainosus. Case Series and Review of Literature.

Background: Intravenous dihydroergotamine (DHE) is frequently used during inpatient hospitalizations or outpatient infusion therapies for 3–5 days in order to break the continuous cycle of status migrainosus. We tried a short term 7 days prophylaxis of oral methylergonovine after discharge in order to prevent status migrainosus relapse and extend the therapeutic benefit from IV DHE.Methods: Patients were diagnosed with status migrainosus in clinic setting based on the ICHD-III criteria. They received 1 mg IV DHE every 8 h along with metoclopramide for 3–5 days followed by methylergonovine maleate oral tablets as prophylaxis for 7 days post discharge. They were asked to maintain their headache diaries which included data on headache frequency and intensity. A post discharge follow up at 1 and 68 weeks was planned. Clinical improvement was defined as >50% decrease in frequency and intensity of headaches. Intensity was graded on verbal numerical rating scale (VNRS) with 10 being the worst possible pain. The institutes IRB and ethics committee exempted this study from review given that it had only 3 patients.Results: A total of 3 patients 25–45 years of age who benefited from IV DHE, consented to trial of Methylergonovine Maleate 0.4 mg oral tablets three times a day prophylaxis on the day of discharge for a period of 7 days. At 1 week post discharge, all of the 3 patients had reported sustained improvement with severity dropping from an average of 8/10 intensity to 3/10 on VNRS. The headaches frequency had dropped from daily to episodic in 2 of the 3 patients. At an average of 7 weeks post discharge, 2 out of the 3 patients had reported sustained benefit. The third patient relapsed to the pre-admission status migrainosus severity. One patient reported mild diarrhea and nausea but was still able to continue the drug for a week.Conclusion: Methylergonovine maleate after 3–5 days of IV DHE infusions may be a feasible treatment strategy for status migrainosus. This approach has the potential to prolonged the benefit of IV DHE and prevent relapse in to status migrainosus.

Effect of Ecbolic Therapy on Postpartum Reproductive Parameters and Serum Hormonal Profile in Dangi Cows

The study was conducted on eighteen dystocia affected Dangi cows to evaluate the effect of ecbolic therapy on postpartum reproductive parameters as well as serum progesterone and estradiol-17β profile. The cows were randomly divided into three groups, each of 6 animals. The cows in Gr-I and Gr-II were injected with Methyl ergometrine (5 mg) and Dinoprost tromethamine (PGF2α, 25 mg) i/m, respectively, immediately after parturition and the cows of Gr-III received herbal ecbolic boli (2-4 boli, bid, PO) for first 10 days postpartum. The blood samples were collected on 0 day (day of calving), 7th day, 14th day, 21st day and 28th day postpartum from the jugular vein. The mean first postpartum estrus interval in Gr-I, Gr-II and Gr-III were 181.50 ± 44.73 days, 195.33 ± 23.38 days and 155.33 ± 27.81 days. The service period was 237.66 ± 28.01 days with 50 per cent (3/6) conception rate in Gr-I and 402.00 ± 46.12 days and 368.66 ± 53.46 days with 100 per cent (6/6) conception rate in each Gr-II and Gr-III, respectively. The postpartum estrus interval and service period did not differ significantly (p&gt;0.05) between Gr-I, Gr-II and Gr-III. A highly significant (p less than 0.01) decrease in both progesterone and estradiol-17β concentration was observed on 7th day postpartum and thereafter fluctuated non-significantly with increasing trend on 14th , 21st and 28th day postpartum in all groups.

A Rare Case of an Arteriovenous Malformation Scar Pregnancy Treated With a Combined and Conservative Approach

A Rare Case of an Arteriovenous Malformation Scar Pregnancy Treated With a Combined and Conservative Approach

Methylergometrine

Methylergometrine

Methylergometrine

Methylergometrine