OBJECTIVE: To determine if intravenous infusion of a combination of oxytocin and ergometrine maleate is better than oxytocin alone to decrease blood lossat caesarean delivery for labour arrest. DESIGN: Prospective, double-blinded, randomised controlled trial. SETTING: Mount Sinai Hospital, Toronto, Canada. POPULATION: Women undergoing caesarean deliveries for labour arrest. METHODS:Forty-eight women were randomised to receive infusion of either ergometrine maleate 0.25 mg + oxytocin 20 iu or oxytocin 20 iu alone, diluted in 1 l of lactated Ringer's Solution, immediately after delivery of the infant. Unsatisfactory uterine contractions after delivery were treated with additional boluses of the study solution or rescue carboprost. Blood loss was estimated based on the haematocrit values before and 48 hours after delivery. MAIN OUTCOME MEASURES: The primary outcome was the estimated blood loss, while the secondary outcomes included the use of additional uterotonics, need for blood transfusion and the incidence of adverse effects. RESULTS: The estimated blood loss was similar in the oxytocin-ergometrine and oxytocin-only groups; 1218 +/- 716 ml and 1299 +/- 774 ml, respectively (P = 0.72). Significantly fewer women required additional boluses of the study drug in the oxytocin-ergometrine group (21 and 57%; P = 0.01). Nausea (42 and 9%; P = 0.01) and vomiting (25 and 4%; P = 0.05) were significantly more prevalent in the oxytocin-ergometrine group. CONCLUSIONS: In women undergoing caesarean delivery for labour arrest, the co-administration of ergometrine with oxytocin does not reduce intraoperative blood loss, despite apparently superior uterine contraction.
RCT Entities:
OBJECTIVE: To determine if intravenous infusion of a combination of oxytocin and ergometrine maleate is better than oxytocin alone to decrease blood loss at caesarean delivery for labour arrest. DESIGN: Prospective, double-blinded, randomised controlled trial. SETTING: Mount Sinai Hospital, Toronto, Canada. POPULATION: Women undergoing caesarean deliveries for labour arrest. METHODS: Forty-eight women were randomised to receive infusion of either ergometrine maleate 0.25 mg + oxytocin 20 iu or oxytocin 20 iu alone, diluted in 1 l of lactated Ringer's Solution, immediately after delivery of the infant. Unsatisfactory uterine contractions after delivery were treated with additional boluses of the study solution or rescue carboprost. Blood loss was estimated based on the haematocrit values before and 48 hours after delivery. MAIN OUTCOME MEASURES: The primary outcome was the estimated blood loss, while the secondary outcomes included the use of additional uterotonics, need for blood transfusion and the incidence of adverse effects. RESULTS: The estimated blood loss was similar in the oxytocin-ergometrine and oxytocin-only groups; 1218 +/- 716 ml and 1299 +/- 774 ml, respectively (P = 0.72). Significantly fewer women required additional boluses of the study drug in the oxytocin-ergometrine group (21 and 57%; P = 0.01). Nausea (42 and 9%; P = 0.01) and vomiting (25 and 4%; P = 0.05) were significantly more prevalent in the oxytocin-ergometrine group. CONCLUSIONS: In women undergoing caesarean delivery for labour arrest, the co-administration of ergometrine with oxytocin does not reduce intraoperative blood loss, despite apparently superior uterine contraction.
Authors: Ioannis D Gallos; Helen M Williams; Malcolm J Price; Abi Merriel; Harold Gee; David Lissauer; Vidhya Moorthy; Aurelio Tobias; Jonathan J Deeks; Mariana Widmer; Özge Tunçalp; Ahmet Metin Gülmezoglu; G Justus Hofmeyr; Arri Coomarasamy Journal: Cochrane Database Syst Rev Date: 2018-04-25