Methylergonovine and Carboprost Equally Effective for Refractory Uterine Atony, finds research
Researchers have identified that methylergonovine maleate and carboprost tromethamine are equivalent in managing refractory uterine atony during cesarean delivery. A new double-blind randomized trial recently performed at two large academic perinatal centers showed that neither agent differed significantly from the other in uterine tone scores 10 minutes after administration. The study was conducted by Cole N. and colleagues which was published in the journal Obstetrics & Gynecology.
Uterine atony is the most common cause of postpartum hemorrhage (PPH), accounting for the majority of maternal morbidity and mortality. Therefore, comparative efficacy and safety studies of the second-line uterotonics commonly administered would be valuable in guiding clinical decisions in obstetric care.
The patients were those with non-emergency cesarean delivery with uterine atony refractory to oxytocin and were randomly assigned intraoperatively to receive a single intramuscular dose of either methylergonovine or carboprost. The main outcome was uterine tone score on a 0–10 numeric rating scale assessed by blinded obstetricians 10 minutes after drug administration.
Secondary outcomes were uterine tone at 5 minutes, requirement for additional uterotonic, blood loss, interventions for uterine atony, postpartum hematocrit change, transfusions, adverse drug reactions, and length of hospitalization. A total number of 50 subjects in each group were calculated to have a 1-point difference on uterine tone scores with 80% power and a two-sided α of 0.05.
Key Findings
Primary Outcome:
• Mean uterine tone scores at 10 minutes:
• Methylergonovine: 7.3±1.7
• Carboprost: 7.6±2.1
• Adjusted mean difference: −0.1 (95% CI, −0.8 to 0.6, p=0.76).
Other Uterotonic Use:
• Methylergonovine arm: 30.0% needed additional uterotonic.
• Carboprost arm: 34.0% needed additional uterotonic.
• AOR: 0.72 (95% CI, 0.27–1.89, p=0.505).
Bleeding:
Geometric mean quantitative blood loss,
• Methylergonovine: 756 mL (95% CI, 636–898).
• Carboprost: 708 mL (95% CI, 619–810).
• Adjustive ratio of geometric mean: 1.06 (95% CI, 0.86–1.31, p=0.588).
Other intervention and safety:
• There was no significant variation in the other interventions with uterine atony or postpartum hemorrhage.
• No notable drug or transfusion reactions.
The study concluded that there is no difference in uterine tone scores or secondary outcomes between methylergonovine and carboprost for refractory uterine atony. The results support the use of either agent as an acceptable second-line uterotonic, offering flexibility and efficacy in managing this critical obstetric condition.
Reference:
Cole, N. M., Kim, J. J., Lumbreras-Marquez, M. I., Fields, K. G., Mendez-Pino, L., Farber, M. K., Carusi, D. A., Toledo, P., & Bateman, B. T. (2024). Second-line uterotonics for uterine atony: A randomized controlled trial. Obstetrics and Gynecology, 144(6), 832. https://doi.org/10.1097/aog.0000000000005744
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