Acta Obstet Gynecol Scand 1998; 77: 54–57 Copyright C Acta Obstet Gynecol Scand 1998

Printed in Denmark – all rights reserved

Acta Obstetricia et
Gynecologica Scandinavica
ISSN 0001-6349

ORIGINAL ARTICLE

Methylergometrine during the early

puerperium; a prospective randomized
double blind study
BENT ANDERSEN, LISE LOTTE TORVIN ANDERSEN AND TORSTEN SØRENSEN
From the Department of Obstetrics and Gynecology, Kolding Hospital, Kolding, Denmark

Acta Obstet Gynecol Scand 1998: 77: 54–57. C Acta Obstet Gynecol Scand 1998

Background. The purpose of the study was to determine the efficacy of 72-hour prophylactic
oral methylergometrine in reducing postpartum hemorrhage and endometritis during the
early puerperium, and the effect of methylergometrine on lochia and requests for analgesics.
Material and methods. A prospective randomized double-blind study was undertaken; a total
of 217 women received 0.2 mg methylergometrine intravenously after delivery of the placenta
and randomized to either tabl. MetherginA 0.125 mg or placebo three times a day for three
days. The main measures were weight of sanitary towels, temperature, consumptions of anal-
gesics and length of hospital stay.
Results. We found no significant difference in the median amount of lochia, the need for
analgesics or length of hospital stay between the two groups. Incidence of infection and
postpartum hemorrhage were low in both groups.
Conclusion. We conclude that prophylactic use of methylergometrine during early puerperium
has no effect on lochia. Endometritis and postpartum hemorrhage were rare in both groups.
There was no increase in requests for analgesics among women given oral methylergometrine.

Key words: lochia; methylergometrine; postpartum hemorrhage; puerperal infection

Submitted 6 November, 1996

Accepted 19 July, 1997

Only a few studies have investigated routine ad-
ministration of methylergometrine in the third
stage of labor and during puerperium. Sorbe (1)
compared patients given methylergometrine and
oxytocin by intravenous injection immediately
after delivery of the anterior shoulder with con-
trols, who did not receive methylergometrine until
after delivery of the placenta. Manual removal of
the placenta was performed significantly more fre-
quently in the methylergometrine group than in
the oxytocin and control group. Blood loss in the
methylergometrine and oxytocin group was sig-
nificantly reduced by one third compared to the
control group.
Matal et al. (2) compared methylergometrine
given immediately after delivery of the anterior
shoulder with controls, who did not receive
C Acta Obstet Gynecol Scand 77 (1998)
methylergometrine and found significantly more
women with heavy bleeding (300 ml or more) in
the control group, but found no significant differ-
ence in hemoglobin concentration between the two
groups.
Prophylactic oral methylergometrine during
early puerperium has been studied (3–6), but these
studies have demonstrated no effect of methylergo-
metrine on complications during the puerperium.
Involution of the uterus has been studied by ul-
trasound (3,4) and no difference was found be-
tween methylergometrine and no treatment.
Arabin and coworkers (3) found significantly
more cases of endometritis and severe afterbleed-
ing in the treated group, and, postpartum pain was
also significantly increased in the methylergomet-
rine group.
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Methylergometrine during the early puerperium 55
Table I. Maternal age and parity, gestational age and fetal birth weight, fre- early second trimester ultrasound examination. All
quency of episiotomy, vacuum extraction and oxytocin augmentation of labor
infants were delivered vaginally after 37 weeks of
in the two groups
gestation and birth weights were within the normal
Methylergometrine Placebo range (between 10th and 90th percentiles of stan-
(nΩ107) (n Ω104) dard intrauterine growth curve).
Mean maternal age (s.d.) 27.7 years (4.2) 27.7 years (3.9)
Randomization, using blinded envelopes, was
Mean parity (s.d.) 1.61 (0.76) 1.76 (0.80) stratified in blocks of 50. Each woman received 0.2
Mean gestational age (s.d.) 280 days (8.2) 281 days (7.6) mg methylergometrine (MetherginA Sandoz) intra-
Mean birth weight (s.d.) 3552 g (457) 3568 g (454) venously after delivery of the placenta and was
Episiotomy (n) 34 (32 %) 34 (33 %)
randomized to either tabl. MetherginA 0.125 mg
Vacuum extraction (n) 5 (4.7 %) 7 (6.7 %)
Oxytocin augmentation of labor (n) 21 (20 %) 31 (30 %) or placebo three times a day for three days.
Lochia were measured by collecting and
weighing sanitary towels. Temperature was meas-
ured rectally every morning according to the rou-
Table II. The amount of lochia, consumption of analgesics and admission time tine of the clinic. Postpartum endometritis was di-
in the two groups agnosed when body temperature 38.0æC or higher
on two readings at an eight-hour interval, com-
Methylergometrine Placebo
(nΩ107) (nΩ104) bined with uterine tenderness, foul smelling lochia
and no other apparent cause of fever.
Median P25 P75 Median P25 P75 Postpartum hemorrhage was defined as loss of
Lochia (g/72 h) 395 295 520 420 330 553
more than 600 ml blood/day. Postpartum the pa-
Paracetamol (g) 0 0 1 0 0 1 tients were give paracetamol on request, and the
Hospital stay (days) 5 4 5 5 3 5 consumption was registered for each patient. No
other analgesics were given.
PΩpercentile.

The present study was undertaken to determine

the efficacy of 72-hour prophylactic oral methyler-
gometrine in reducing postpartum hemorrhage
and endometritis during the puerperium, and, the
effect of methylergometrine on lochia and requests
for analgesics.

Material and methods

The study is a prospective double-blind ran-
domized trial of oral methylergometrine versus
placebo. Assuming a log-normal distribution for
lochia with a standard deviation of 110 g (3), it
was estimated that a sample size of 102 patients
per group was required to show a clinically rel-
evant reduction of lochia of 50 g with an error rate
of 0.05 (two-sided) and a power of 0.90.
The study was approved by the ethical commit-
tee of the counties of Fyn and Vejle. Standardized
informed consent was obtained from each woman.
A total of 217 women with a single pregnancy
and no evidence of maternal pregnancy compli-
cations and no contra-indications for methylergo-
metrine (hypertension and vascular diseases), ad-
mitted to Kolding Hospital, Department of Ob-
stetrics and Gynecology, between November 16
1992 and December 4 1993 agreed to participate
in the study.
Gestational age was estimated from the first day Fig. 1. The distribution of the amount of lochia in the two
of the last menstrual period, and confirmed by groups.

C Acta Obstet Gynecol Scand 77 (1998)


56 B. Andersen et al.
Fig. 2. The consumption of paracetamol in the two groups.
Results
During the study period 111 women were ran-
domized to the methylergometrine group. Four
women in this group were excluded: one because
of hypertension; one wished to go home early; two
forgot to take their tablets.
A total of 106 women were randomized to the
placebo group. Two women in this group were ex-
cluded: one forgot to collect sanitary towels and
one wished to go home early.
Age, parity, gestational age, birth weight and use
of episiotomy, vacuum extraction and oxytocin
augmentation of labor were comparable among
the two groups (Table I).
The median amount of lochia during the first
72-hour of the puerperium was 395 g in the treat-
ment group, and, 420 g in the placebo group (Table
II).
Fig. 1 shows the distribution of lochia among
the two groups. Linear regression analysis of birth
weight and amount of lochia showed no corre-
C Acta Obstet Gynecol Scand 77 (1998)
16000412, 1998, 1, Downloaded from https://obgyn.onlinelibrary.wiley.com/doi/10.1034/j.1600-0412.1998.770112.x by Nat Prov Indonesia, Wiley Online Library on [02/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
lation. The correlation coefficient was 0.124 in the
treatment group and 0.009 in the placebo group.
Incidence of endometritis was low in both
groups. Two women (1.87 %) in the treatment and
one (0.96 %) in the placebo group had postpartum
endometritis diagnosed.
None of controls and only one (0.96 %) in the
treatment group had postpartum hemorrhage and
underwent curettage the tenth day after delivery to
remove placental fragments.
Requests for paracetamol were comparable
among the two groups (Table II); 53% of the
women in the treatment group and 61% in the pla-
cebo group did not request analgesics (Fig. 2).
The median hospital stay was the same in the
two groups (Table II).
Discussion
Previous findings (2–6) show that complications
during the puerperium are poorly related to the
prophylactic administration of methylergometrine.
Our results do not indicate that use of oral methyl-
ergometrine after normal vaginal delivery reduces
the amount of lochia.
Arabin et al. (3) reported, in a placebo con-
trolled study based on 880 puerperae, no reduction
in lochia and no change in involution of the uterus
in the methylergometrine group; but there was a
significantly increased number of women with
endometritis and severe after-bleeding and in-
creased postpartum pain score in the methylergo-
metrine group.
In our study we found the incidence of endo-
metritis and postpartum hemorrhage low in both
groups, and we found no increase in requests for
analgesics among patients in the methylergomet-
rine group. There was no correlation between fetal
weight and the amount of lochia.
We conclude that prophylactic use of oral
methylergometrine in early puerperium has no ef-
fect on the amount of lochia. There is no corre-
lation between fetal weight and the amount of lo-
chia, and no increase in requests for analgesics
among women given oral methylergometrine.
Acknowledgment
We are grateful to pharmacist Thorkild Møller, Kolding Hospi-
tal, who supplied the methylergometrine and the placebo tab-
lets.
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