Comparative Study of Methylergometrine and Oxytocin in the PREVENTION of Primary Postpartum Haemorrhage

Background: Primary postpartum haemorrhage (PPPH) is a major cause of maternal mortality especially in low income countries. Reducing the likelihood of PPPH by routine active management of third stage of labour (AMSTL) can help reduce the maternal mortality associated with it.

Methodology: It was a randomized comparative study which compared the efficacy and safety of intramuscular methyl-ergometrine with intramuscular oxytocin in the third stage of labour. Four hundred and ninety two women undergoing normal vaginal delivery were recruited and randomized to group A and B with two hundred and forty six in each group. Group A received 0.2mg methyl-ergomertine intramuscularly and Group B received 10 i.u. oxytocin intramuscularly immediately after delivery of the baby. The efficacy and safety of these two drugs were analyzed based on percentage fall in haemoglobin (Hb) level, need for additional uterotonic agents, need for exploration and uterine evacuation, need for blood transfusion, duration of the third stage of labour, elevation of blood pressure, number of patients with retained placenta and the need for manual removal of placenta (MRP). All data were analyzed using the Statistical Package for Social Sciences (SSPS) version 16.

Results: Fall in haemoglobin, mean blood loss, duration of third stage of labour, need for additional uterotonics, and blood transfusion were significantly less in group A. There was significant difference (p 0.003) in the mean intra-partum blood loss between the methyl-ergometrine (166.4±92.0ml) and oxytocin (207.4±196.9ml) groups. However side effects like nausea, vomiting and rise in systolic and diastolic blood pressure were higher in women in group A. Only the diastolic blood pressure elevation was statistically significant (p < 0.0001).

Conclusion: Methyl-ergometrine is suggested to be superior to intramuscular oxytocin in controlling primary post-partum haemorrhage. Its use might be encouraged for the active management of the third stage of labour, especially in those without any contra-indication to its use.