Methylergonovine Substantially Reduces Blood Loss in Twin Cesarean Deliveries: Study
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A recent study published in *Pregnancy* indicates that prophylactic intramuscular (IM) methylergonovine, administered post-umbilical cord clamping, significantly curtails intraoperative blood loss during twin cesarean deliveries (CD). The research, which involved 66 participants, also showed a reduction in the drop in hemoglobin levels on postoperative day 1. This suggests that methylergonovine coudl minimize the risk of postpartum hemorrhage, a leading cause of maternal morbidity and mortality, in women with twin pregnancies. The findings offer a promising strategy for improving obstetrical management and patient outcomes.
The Challenge of Postpartum Hemorrhage in Twin Pregnancies
Twin pregnancies present unique challenges, notably concerning postpartum hemorrhage. The overdistension of the uterus in twin gestations can impair myometrial contractility after delivery, increasing the likelihood of excessive bleeding. This heightened risk underscores the need for effective strategies to manage and prevent postpartum hemorrhage in this specific patient population.
Researchers emphasized the importance of therapeutic interventions when initial treatments prove insufficient.
Therapeutic adjuncts to oxytocin are needed when uterine atony is refractory to initial therapy.
They further explained the rationale behind investigating methylergonovine:
Methylergonovine is a fast-acting, semisynthetic ergot alkaloid that has been shown to minimize intraoperative blood loss when used prophylactically in singleton pregnancies.
Study Design and Methodology
The study aimed to evaluate the efficacy of prophylactic IM methylergonovine in reducing blood loss during twin cesarean deliveries. Participants included pregnant adults with twin gestations of at least 34 weeks,all scheduled for CD. Exclusion criteria included placental or uterine anomalies and any contraindications to methylergonovine. Participants were randomly assigned in a 1:1 ratio to recieve either methylergonovine or a placebo.
Before delivery, a complete blood count was performed within 72 hours to establish preoperative hemoglobin levels.All participants received neuraxial anesthesia, along with an oxytocin infusion of 500 mL/h for one hour, followed by 125 mL/h for four hours after the clamping of the second twin’s umbilical cord. Promptly after cord clamping, either intramuscular methylergonovine 0.2 mg or an intramuscular placebo was administered. All patients received standard postoperative care.
Key Outcome Measures
The primary outcome was maternal blood loss, assessed by comparing maternal hemoglobin levels on postoperative day 1 with preoperative levels. The contents of suction canisters were also measured to quantify blood loss. Secondary outcomes included the incidence of postpartum hemorrhage, estimated blood loss, the need for blood transfusions, the management of additional uterotonics, surgical time, the use of intrauterine balloon tamponade or vacuum-induced uterine tamponade devices, B-lynch suture placement, and the use of hemostatic sealant agents.
Study Results: Reduced Blood Loss with Methylergonovine
The final analysis included 66 participants, with a median gestational age of 37 weeks at delivery. The demographic characteristics of the two groups were similar, with preoperative hemoglobin levels averaging 11.6 g/dL in the methylergonovine group and 12 g/dL in the placebo group.
The methylergonovine group experienced a mean decrease in maternal hemoglobin level of -1.1 g/dL from preoperative levels to postoperative day 1, compared to a decrease of -2.1 g/dL in the placebo group. This translated to an adjusted mean decrease of 1 g/dL in maternal hemoglobin among patients receiving methylergonovine compared to those receiving the placebo.
While surgical times were comparable between the groups, the need for additional interventions differed. One patient in the placebo group required a B-Lynch suture, and six placebo patients needed two or more intraoperative medications. Notably, the methylergonovine group exhibited significantly less quantitative blood loss, with a median of 891 mL compared to 1017 mL in the placebo group.
Moreover, the methylergonovine group showed lower estimated blood loss (800 mL vs. 1000 mL) and a reduced incidence of postpartum hemorrhage (6% vs. 18%) compared to the placebo group. The need for blood transfusions was also lower in the methylergonovine group, with two patients requiring transfusion compared to four in the placebo group.
Conclusion: A Promising Preventative Strategy
The study’s findings strongly suggest that prophylactic administration of methylergonovine after umbilical cord clamping in twin cesarean deliveries significantly reduces intraoperative blood loss. This indicates that methylergonovine could be a valuable preventative treatment strategy for mitigating the risk of postpartum hemorrhage in this high-risk patient population.
The investigators concluded:
These data support further study of methylergonovine as a preventative treatment strategy at the time of twin CD with the potential to reduce the risk of postpartum hemorrhage and associated sequelae in this at-risk patient population.
References
- Gomez Slagle HB, miller R, Bejerano S, Goffman D, D’alton ME, mourad M. Intramuscular methylergonovine to decrease blood loss during cesarean delivery for twins: A triple-blinded placebo-controlled randomized trial. *Pregnancy.* 2025.doi:10.1002/pmf2.12039
- Bienstock JL,Eke AC,Hueppchen NA. Postpartum Hemorrhage. *N Engl J Med*. 2021;384(17):1635-1645. doi:10.1056/NEJMra1513247
Preventing Postpartum Hemorrhage in Twins: A Breakthrough Study on Methylergonovine
Did you know that twin pregnancies significantly increase the risk of life-threatening postpartum hemorrhage? This alarming statistic underscores the importance of preventative strategies,and a recent study offers a promising solution. We spoke with Dr. Evelyn Reed, a leading OB/GYN specializing in high-risk pregnancies, to delve into the groundbreaking research on methylergonovine.
World-Today-News: Dr. Reed, the study published in Pregnancy highlights the potential of prophylactic methylergonovine in reducing blood loss during twin cesarean deliveries. Can you explain the significance of this finding for expectant mothers and healthcare providers?
Dr. Reed: The study’s findings are indeed significant. Postpartum hemorrhage (PPH), defined as excessive bleeding after childbirth, is a leading cause of maternal mortality and morbidity worldwide. This risk is substantially elevated in twin pregnancies due to uterine atony—the inability of the uterus to contract effectively after delivery. The uterus, overstretched by the twins, struggles to clamp down on blood vessels, leading to significant blood loss. The study demonstrates that prophylactic methylergonovine, administered after the umbilical cord is clamped, significantly reduces this blood loss. For healthcare providers,this means a perhaps life-saving preventative measure. For expectant mothers carrying twins, it offers a new layer of safety and reduces the anxiety associated with this known risk.
World-Today-News: Methylergonovine is a semisynthetic ergot alkaloid. Could you elaborate on its mechanism of action and why it’s particularly effective in this context?
Dr. Reed: Methylergonovine’s effectiveness stems from its potent uterotonic properties. This means it directly stimulates uterine contractions, helping constrict blood vessels and minimize bleeding.It’s a fast-acting medication,making it ideal for the immediate postpartum period when speedy intervention is crucial to control blood loss. Moreover, while oxytocin is a commonly used uterotonic, it isn’t always sufficient, especially in cases of uterine atony following twin deliveries. Methylergonovine can act as a valuable adjunct, bolstering the effects of oxytocin and ensuring effective uterine contraction. This makes it a crucial therapeutic option in managing PPH.
World-Today-News: The study mentions a triple-blinded, placebo-controlled randomized trial. Why is this rigorous methodology crucial in evaluating the efficacy of methylergonovine?
Dr. Reed: this rigorous study design is paramount to establish the true efficacy of methylergonovine. A randomized controlled trial (RCT) ensures that participants are randomly assigned to either the treatment group (receiving methylergonovine) or the control group (receiving a placebo), minimizing bias and confounding variables. The triple-blinding—where neither the participants, researchers, nor data analysts know who received which treatment—further enhances objectivity and minimizes the risk of subjective interpretation of results. This is essential to confidently conclude that the observed reductions in blood loss are directly attributable to methylergonovine and not to chance or other factors. This strong methodology provides robust evidence, increasing confidence in the results of the study.
World-Today-News: Are there any contraindications or potential side effects associated with methylergonovine that healthcare professionals should be aware of?
Dr. Reed: As with any medication, methylergonovine has potential side effects. These can include hypertension,nausea,vomiting,and headache.There are also specific contraindications including conditions such as pre-eclampsia, severe hypertension, eclampsia, and coronary artery disease. Thus, careful screening of patients is essential before administering methylergonovine. Healthcare professionals must thoroughly assess patient history and carefully weigh the benefits against the risks before prescribing this medication. open and honest communication with the patient regarding potential side effects is vital.
World-Today-News: What are the key takeaways from this research for obstetricians and gynecologists managing high-risk pregnancies?
Dr. Reed: The key takeaways are clear:
Methylergonovine shows promise as a safe and effective prophylactic treatment to reduce blood loss in twin pregnancies.
It may significantly lower the incidence of postpartum hemorrhage, a leading cause of both maternal morbidity and mortality.
Healthcare professionals should consider methylergonovine as part of their management strategy for twin deliveries, especially in cases where uterine atony is a concern. However, this should always be done following established clinical guidelines and considerations for individual patient conditions.
Further research is needed to fully understand the long-term benefits and potential risks. While this study provides valuable findings, additional research is certainly crucial to reinforce the potential benefits of methylergonovine.
World-Today-News: Thank you, Dr. Reed,for shedding light on this crucial research. This is truly a step forward in improving maternal outcomes in high-risk pregnancies.
What are your thoughts on the potential of methylergonovine in reducing postpartum hemorrhage in twin deliveries? Share your comments below or join the discussion on social media!