Publication:

A randomised controlled study for the prevention of post-partum haemorrhage with oxytocin plus methyl ergometrine versus oxytocin alone in the third stage of labour

Background Postpartum haemorrhage is the leading cause of maternal death. Uterine atony which is preventable, causes 80% of Post partum haemorrhage (PPH). Active management of third stage of labour (AMTSL) lowers maternal blood loss and reduces the risk of PPH. In this open labelled randomised controlled study we compared the combined use of oxytocin and methyl ergometrine vs oxytocin alone in prevention of PPH in the third stage of labour.

Methods 200 Women admitted for safe confinement and following the inclusion criteria were randomised immediately post delivery to receive either oxytocin +methyl ergometrine or oxytocin alone. The amount of blood loss was assessed objectively by weighing the mops and under sheets used during delivery. If bleeding could not be controlled, additional uterotonics were given. The incidence of PPH, amount of blood loss, use of additional uterotonics and side effects were recorded. The difference in pre natal and post natal haemoglobin (Hb) and the need for blood transfusion were assessed.

Results There was no statistically significant difference in the incidence of PPH between the groups. Post partum blood loss was significantly lesser in the combined group. Additional oxytocics were required more often in the oxytocin only group. The incidence of headache was significantly more in the combined group. The difference in haemoglobin levels post natally and the need for blood transfusion was comparable among both groups.

Conclusions The combined use of methyl ergometrine +oxytocin is not recommended over oxytocin alone in the third stage of labour for prevention of PPH.