Intramuscular methylergonovine to decrease blood loss during cesarean delivery for twins: A triple-blinded...

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Pharmacology

Background:

• Cesarean delivery (CD) in twin pregnancies carries a higher risk of postpartum hemorrhage.
• Standard oxytocin prophylaxis may be insufficient to prevent significant blood loss in these high-risk cases.

Purpose of the Study:

• To evaluate the efficacy of prophylactic intramuscular methylergonovine in reducing blood loss during planned cesarean delivery for twin pregnancies.
• To compare maternal hemoglobin drop and postpartum hemorrhage rates between methylergonovine and placebo groups.

Main Methods:

• A single-center, randomized, placebo-controlled, triple-blinded trial involving 66 patients undergoing planned CD for twin gestations.
• Intramuscular methylergonovine or saline placebo was administered after umbilical cord clamping of the second twin, in addition to standard oxytocin.
• Primary outcome: change in mean maternal hemoglobin (Hgb) from preoperative to postoperative day 1 (POD 1).

Main Results:

• Mean Hgb drop on POD 1 was significantly lower in the methylergonovine group (1.1 g/dL) compared to the placebo group (2.1 g/dL) (p < 0.001).
• Quantitative blood loss was significantly reduced with methylergonovine (891 mL vs. 1017 mL, p = 0.003).
• Postpartum hemorrhage rates were substantially lower in the methylergonovine group (18.2%) versus the placebo group (54.5%) (p = 0.002).

Conclusions:

• Prophylactic intramuscular methylergonovine significantly reduces intraoperative blood loss and hemoglobin drop following cesarean delivery in twin pregnancies.
• These findings suggest methylergonovine is a promising preventative treatment strategy for managing blood loss during twin cesarean deliveries.