A comparative study of methylergonovine and 15-methyl prostaglandin F2alpha in active management of third stage of labor

OBJECTIVE: Postpartum hemorrhage is most common cause of maternal mortality. Active management of third stage of labor minimizes the risk of postpartum hemorrhage. To compare the effect of methylergonovine and 15-methyl prostaglandin F2alpha (15-methyl PGF2alpha) in active management of third stage of labor. METHODS: A randomized open labelled parallel study with 50 women in normal labor, 25 in each group were included. The drugs methylergonovine (0.2 mg) intravenous and 15-methyl PGF2alpha (250 microg) intramuscular were administered at the time of delivery of anterior shoulder. Main outcomes measured were amount of blood loss during the first four hours of delivery and objective measurement of hemoglobin and hematocrit levels before delivery and third day postpartum. RESULTS: There was no statistically significant difference in the blood loss between the two groups at delivery (P = 0.130), at 1 hour of delivery (P = 0.453). The blood loss with 15-methyl PGF2alpha was significantly less as compared to that of blood loss with methylergonovine at four hours of delivery (P = 0.014) and the total, i.e., during first four hours, amount of blood loss was significantly less with 15-methyl PGF2alpha (P = 0.026). There was no statistically significant difference in the hemoglobin and hematocrit levels measured predelivery and postpartum third day between both the drugs. CONCLUSION: Both the drugs were effective in controlling the amount of blood loss during the third stage of labor, 15-methyl PGF2alpha being more efficacious.

Does Methergine Aggravate Chest Symptom and/or Electrocardiographic Changes during Cesarean Delivery under Spinal Anesthesia? / 대한마취과학회지

BACKGROUND: Complaints of chest symptoms including pressure, tightness, or pain frequently occur during cesarean delivery under regional anesthesia. The aim of this study was to test whether methergine (methylergonovine maleate) aggravates chest symptoms and/or ECG changes during cesarean section under spinal anesthesia, and to determine if these changes are associated with any discernable intraoperative event. METHODS: After delivery, patients were given intravenous methergine 0.2 mg and diluted oxytocin 10 i.u. in 1000 ml Ringer's lactate solution (Methergine group, n = 30) or diluted oxytocin 20 i.u. (Control group, n = 29). ECG and hemodynamic responses were monitored continuously on 12 leads perioperatively. RESULTS: Methergine significantly increased the incidence of chest symptoms compared to the control group (30% vs. 3.4%, P 0.05). CONCLUSIONS: Methergine-induced chest symptoms per se do not signify evident myocardial ischemia during cesarean delivery. However, anesthesiologists must not overlook the possibility of a small coronary arteriolar spasm, especially in high-risk patients.

Effects of Vasoactive Drugs on Blood Flow in Rabbits: Photoplethysmographic Assessment / 대한정형외과학회잡지

The dynamic blood flow is regulated by the numerous complex mechanisms. Since blood flow varies directly with the radius of the vessel, blood flow is markedly affected by small changes in the caliber of the vessels. Using the hotoplethysmography, we assessed the relative changes of blood flow after topical application of the vasoactive drugs to the femoral arteries of the rabbits. It is the purpose of this study to evaluate the immediate and delayed effects of the vasoactive drugs such as epinephrine, methylergonovine, chymopapain, and lidocaine in course of time when the drugs applied topically to the vessel. 60 rabbits were divided into 6 experimental groups. In group I, the femoral artery was surgically exposed only. In Group g-A, epinephrine was applied to the femoral artery after surgical exposure. In Group Il-B, after spplication of epinephrine, the effect of epiniphrine was reversed with lidocaine. Another drugs were applied as follows methylergonovine in Group Hl-A, methylergonovine and lidocaine in Group Ill-B as in group Il-B, Chymopapain in Group lV. The relstive changes of blood flow were measured by the photoplethymograph for 3 weeks. The results are as follows ; 1. The amplitude of the photoplethysmographic wave decreased immediately after the topical application of epinephrine, methylergonovine and chymopapain. Such an effect could be observed until the 3rd week after the topical application of the drugs, 2. The delayed dffect of reducing the amplitude could be seen during the 1st week in the epinephrine and methylergonovine treated groups. However, it was seen after 1st week in the chymopapain treated group. 3. The delayed effect of epinephrine and methylergonovine could be reversed with lidocaine. 4. It seems that lidocaine can be used clinically to preyent the delayed effect of epinephrine and methylergonovine.