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In this study, we sought to demonstrate the benefit of postpartum hemorrhage prophylaxis treatment and the superiority of methylergonovine-oxytocin combination over oxytocin in terms of hemodynamic stability and amount of bleeding during cesarean section. In this retrospective study, 400 patients who had a cesarean section in the same clinic were divided into two groups and included in this study. The first group consisted of nulliparous patients (n=141) who gave birth by cesarean for the first time and the second group consisted of multipar patients (n=259) who gave birth by cesarean section before. Then both main groups; women who received only oxytocin infusion in the intraoperative and postoperative periods were divided into (monotherapy group), women who received methylergonovine and oxytocin therapy in the intraoperative and postoperative periods were divided into 2 more subgroups (combined group). For comparison, samples for preoperative and postoperative complete blood counts were obtained from all patients in each group. When the postoperative Hb levels of nulliparous pregnant women were compared, it was seen that the decrease in Hb levels was less in the group that received methylergonovine in addition to oxytocin (p=0.031). Similarly, Hb decrease was observed less in the group given methylergonovine in addition to oxytocin in multiparous pregnant women (p=0.045). The group that received methylergonovine in addition to oxytocin provided more hemodynamic stability in both the nulliparous and multiparous cesarean section groups, which we divided according to the number of cesarean sections, compared to the group that received oxytocin; significantly reduced the level of bleeding. We think that this form of treatment will also reduce the risk of uterine atony; therefore (if there is no coronary disease) we recommend it to be used under spinal anaesthesia. [Med-Science 2022; 11(4.000): 1608-12]

In this study, we sought to demonstrate the benefit of postpartum hemorrhage prophylaxis treatment and the superiority of methylergonovine-oxytocin combination over oxytocin in terms of hemodynamic stability and amount of bleeding during cesarean section. In this retrospective study, 400 patients who had a cesarean section in the same clinic were divided into two groups and included in this study. The first group consisted of nulliparous patients (n=141) who gave birth by cesarean for the first time and the second group consisted of multipar patients (n=259) who gave birth by cesarean section before. Then both main groups; women who received only oxytocin infusion in the intraoperative and postoperative periods were divided into (monotherapy group), women who received methylergonovine and oxytocin therapy in the intraoperative and postoperative periods were divided into 2 more subgroups (combined group). For comparison, samples for preoperative and postoperative complete blood counts were obtained from all patients in each group. When the postoperative Hb levels of nulliparous pregnant women were compared, it was seen that the decrease in Hb levels was less in the group that received methylergonovine in addition to oxytocin (p=0.031). Similarly, Hb decrease was observed less in the group given methylergonovine in addition to oxytocin in multiparous pregnant women (p=0.045). The group that received methylergonovine in addition to oxytocin provided more hemodynamic stability in both the nulliparous and multiparous cesarean section groups, which we divided according to the number of cesarean sections, compared to the group that received oxytocin; significantly reduced the level of bleeding. We think that this form of treatment will also reduce the risk of uterine atony; therefore (if there is no coronary disease) we recommend it to be used under spinal anaesthesia. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of intramuscular methylergonovine maleate as prophylaxis against excessive bleeding when given after dilation and evacuation (D&E) at 20-24 weeks.Study Design: We performed a randomized, double-blinded, placebo-controlled trial in patients without excessive bleeding requiring intervention after D&E completion. We administered study treatment within one minute of the end of the procedure. We primarily compared outcomes using a composite of indicators of excessive post-procedure blood loss (post-procedure measured blood loss exceeding 125 mL, uterine massage or compression for at least two minutes, administration of additional uterotonic medication, intrauterine balloon tamponade, uterine re-aspiration, blood transfusion, uterine artery embolization, hospital admission for bleeding, or major surgery). Secondary outcomes included individual indicator occurrences, satisfaction, and side effects.Results: From March 3, 2015 to March 31, 2017, we randomized 284 participants (n = 140 methylergonovine, n = 144 placebo), five before we registered the trial with clinicaltrials.gov. Baseline characteristics were similar between groups. The composite outcome occurred in 78 (56%) methylergonovine and 75 (52%) placebo participants (p = 0.5). Methylergonovine recipients required more intrauterine balloon use (n = 20 [14%]) versus placebo (n = 10 [7%]), p = 0.04. We also observed a non-significant trend towards more uterotonic administration (n = 56 [40%] versus n = 43 [30%], p = 0.07) and hospital admissions for bleeding (n = 4 [3%] versus n = 0, p = 0.06) in the methylergonovine group compared to placebo.Conclusion: We observed no improvement in the composite outcome for excessive bleeding with prophylactic post-procedure methylergonovine. In addition, individual excessive bleeding outcomes occurred more frequently in the methylergonovine group, potentially indicating harm with its prophylactic use after D&E.Implications: When administered prophylactically immediately after dilation and evacuation abortion at 20-24 weeks, methylergonovine increases uterine bleeding. Given the lack of data for effectiveness as a prophylactic agent and our findings indicating harm, we do not recommend its use for post-operative prophylaxis. [ABSTRACT FROM AUTHOR]

Background: Intravenous dihydroergotamine (DHE) is frequently used during inpatient hospitalizations or outpatient infusion therapies for 3–5 days in order to break the continuous cycle of status migrainosus. We tried a short term 7 days prophylaxis of oral methylergonovine after discharge in order to prevent status migrainosus relapse and extend the therapeutic benefit from IV DHE.Methods: Patients were diagnosed with status migrainosus in clinic setting based on the ICHD-III criteria. They received 1 mg IV DHE every 8 h along with metoclopramide for 3–5 days followed by methylergonovine maleate oral tablets as prophylaxis for 7 days post discharge. They were asked to maintain their headache diaries which included data on headache frequency and intensity. A post discharge follow up at 1 and 68 weeks was planned. Clinical improvement was defined as >50% decrease in frequency and intensity of headaches. Intensity was graded on verbal numerical rating scale (VNRS) with 10 being the worst possible pain. The institutes IRB and ethics committee exempted this study from review given that it had only 3 patients.Results: A total of 3 patients 25–45 years of age who benefited from IV DHE, consented to trial of Methylergonovine Maleate 0.4 mg oral tablets three times a day prophylaxis on the day of discharge for a period of 7 days. At 1 week post discharge, all of the 3 patients had reported sustained improvement with severity dropping from an average of 8/10 intensity to 3/10 on VNRS. The headaches frequency had dropped from daily to episodic in 2 of the 3 patients. At an average of 7 weeks post discharge, 2 out of the 3 patients had reported sustained benefit. The third patient relapsed to the pre-admission status migrainosus severity. One patient reported mild diarrhea and nausea but was still able to continue the drug for a week.Conclusion: Methylergonovine maleate after 3–5 days of IV DHE infusions may be a feasible treatment strategy for status migrainosus. This approach has the potential to prolonged the benefit of IV DHE and prevent relapse in to status migrainosus.

Raynaud's disease is a medical condition in which arterial spasm causes episodes of reduced blood flow, in the setting of certain triggers such as cold weather. Patients with this condition are at risk of adverse reactions if they receive medications with vasoactive properties. Methylergonovine maleate is one drug used during cesarean delivery to treat postpartum hemorrhage due to uterine atony. By acting directly on uterine and vascular smooth muscle, it produces cardiovascular responses such as coronary vasospasm, myocardial infarction, and even cardiac arrest. However, pulmonary events have rarely been reported. We report our anesthetic management of a 36-year-old patient, with undiagnosed Raynaud's disease and undergoing cesarean delivery, who experienced new onset acute pulmonary edema after methylergonovine administration to manage postpartum hemorrhage. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to document current practices of abortion providers on the use of medications to decrease bleeding during surgical abortion.Study Design: We emailed surveys to 336 abortion providers through a professional listserv to elicit information on their use of medications to prevent and treat bleeding during first- and second-trimester surgical abortion.Results: One hundred sixty-eight (50%) providers responded to our survey. The majority were obstetrician-gynecologists (83%) working in an academic practice (66%). Most completed a fellowship in family planning (87%) and currently perform abortions up to 22 or 24weeks of gestation (63%). Seventy-two percent routinely used prophylactic medications for bleeding. Providers who routinely used medications to prevent bleeding most commonly chose vasopressin (83%). Providers preferred methylergonovine as a treatment for excessive bleeding in the second trimester, followed by misoprostol.Conclusion: We found that most providers routinely use medications to prevent bleeding and use several different regimens to treat bleeding during abortion.Implications: We found that surgical abortion providers use a range of medications to prevent and treat hemorrhage at the time of surgical abortion. Scant evidence is available to guide abortion providers on the use of medications to decrease hemorrhage during surgical abortion. To provide evidence-based recommendations for the prevention and treatment of clinically significant bleeding, researchers should target the most commonly used interventions. [ABSTRACT FROM AUTHOR]

Introduction: the obstetric hemorrhage is the main cause of maternal death in the world. In Colombia the postpartum hemorrhage is the second cause of deaths associated with the pregnancy. It could be primary (PPH) or secondary. The primary ones appear in the first 24 hours after the birth and are the most frequent. Objective: To identify the etiological factors and the therapeutic proposals for the management of the PPH. Methods: Electronic search was carried out in the databases PubMed, ScienceDirect, EBSCOhost, Ovid and scielo, textbook of obstetric and guidelines for its management published since January, 2005 to December, 2013. Also, in the documents and guidelines of the Ministerio de Salud y Protección Social de Colombia. Results: 52 studies were selected for review and there were chosen 30 that were achieving with the inclusion criteria. Conclusions: The etiological factors are remembered by the mnemonic of the 4Ts (Tonus, trauma, tissue and thrombin). The uterine atony (uterine tonus disorder) is presented in the 80% of the cases and its management consists in uterine massage, Oxytocin, Methylergonovine and Misoprostol use. Between the non-pharmacological measures are cited the bakri balloon, embolization, hypogastric or uterine arteries ligation, B-Lynch´s surgery and subtotal or total abdominal hysterectomy. The other causes of PPH are the injuries of the channel of the childbirth, the retention of remains and the coagulation disorders, that have specific management. The identification of the etiological factors for PPH allows the early standard for the management, which avoids the morbidity and reduces the mortality. It is fundamental the implementation of institutional protocols. Rev.cienc.biomed.2014;5(2):307-316. KEYWORDS Postpartum hemorrhage, Oxytocin, Methylergonovine, Misoprostol

Objective: To evaluate maternal and breastfed infant's outcome following post-partum maternal use of methylergonovine.Methods: A prospective, controlled observational study design was used. Mothers who contacted Beilinson Teratology Information Service (BELTIS) were followed by phone interview. Data on lactation, neonatal symptoms and outcomes at the age of 1-3 years were obtained. Mothers' breastfeeding while treated with methylergonovine and their infants were compared to a matched control group of breastfeeding mothers using a drug known to be safe during lactation (amoxicillin).Results: Follow-up was obtained for 38 of 42 women (90.5%). Of whom, six stopped breastfeeding because of concerns regarding drug treatment and three refused to participate. The remaining 29 women and infant pairs were compared to a control group of 58 women and their infants. Comparison showed no effect of methylergonovine on lactation and similarly showed no difference in rate of neonatal complications (p = 1). At time of follow-up there were no differences in growth or in adverse neurodevelopment outcomes (p = 0.26).Conclusions: No increase in adverse long-term outcomes was found in infants exposed to methylergonovine through breastfeeding. Our data in conjunction with previous estimates of very low drug exposure support continuation of breastfeeding in women requiring treatment with methylergonovine. [ABSTRACT FROM AUTHOR]

The study intends to repurpose FDA drugs and investigate the mechanism of (5HT 2B R) activation by comprehending inter-residue interactions. The 5HT 2B R is a novel thread, and its role in reducing seizures in Dravet syndrome is emerging. The crystal structure (5HT 2B R) is a chimera with mutations; hence 3D-structure is modeled (4IB4: 5HT 2B R M ). The structure is cross-validated to simulate the human receptor using enrichment analysis (ROC: 0.79) and SAVESv6.0. Virtual screening of 2456 approved drugs yielded the best hits that are subjected to MM/GBSA and molecular dynamic (MD) simulations. The 2 top drugs Cabergoline (-53.44 kcal/mol) and Methylergonovine (-40.42 kcal/mol), display strong binding affinity, and ADMET/SAR analysis also suggests their non-mutagenic or non-carcinogenic nature. Methylergonovine has a weaker binding affinity and lower potency than standards [Ergotamine (agonist) and Methysergide (antagonist)] due to its higher K i (1.32 M) and K d (6.44 ×10 -8 M) values. Compared to standards, Cabergoline has moderate binding affinity and potency [K i = 0.85 M and K d = 5.53 × 10-8 M]. The top 2 drugs primarily interact with conserved residues (ASP135, LEU209, GLY221, ALA225, and THR140) as in agonists, unlike the antagonist. The top 2 drugs, upon binding to the 5HT 2B R M, modify the helices VI, V, and III and shift the RMSD 2.48 Å and 3.07 Å. LEU209 forms a latch with residues 207-214 (forms a lid) in the 5HT 2B R M receptor, which enhances agonist binding and prevents drug escape. Methylergonovine and Cabergoline interact more stongly with ALA225 than the antagonist. The post-MD analysis of Cabergoline suggests a better MM/GBSA value (-89.21 kcal/mol) than Methylergonovine (-63.54 kcal/mol). In this study, Cabergoline and Methylergonovine's agonistic mechanism and solid binding properties suggest their strong role in regulating the 5HT 2B R and might target drug-resistant epilepsy., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Intravenous dihydroergotamine (DHE) is frequently used during inpatient hospitalizations or outpatient infusion therapies for 3–5 days in order to break the continuous cycle of status migrainosus. We tried a short term 7 days prophylaxis of oral methylergonovine after discharge in order to prevent status migrainosus relapse and extend the therapeutic benefit from IV DHE. Methods: Patients were diagnosed with status migrainosus in clinic setting based on the ICHD-III criteria. They received 1 mg IV DHE every 8 h along with metoclopramide for 3–5 days followed by methylergonovine maleate oral tablets as prophylaxis for 7 days post discharge. They were asked to maintain their headache diaries which included data on headache frequency and intensity. A post discharge follow up at 1 and 68 weeks was planned. Clinical improvement was defined as >50% decrease in frequency and intensity of headaches. Intensity was graded on verbal numerical rating scale (VNRS) with 10 being the worst possible pain. The institutes IRB and ethics committee exempted this study from review given that it had only 3 patients. Results: A total of 3 patients 25–45 years of age who benefited from IV DHE, consented to trial of Methylergonovine Maleate 0.4 mg oral tablets three times a day prophylaxis on the day of discharge for a period of 7 days. At 1 week post discharge, all of the 3 patients had reported sustained improvement with severity dropping from an average of 8/10 intensity to 3/10 on VNRS. The headaches frequency had dropped from daily to episodic in 2 of the 3 patients. At an average of 7 weeks post discharge, 2 out of the 3 patients had reported sustained benefit. The third patient relapsed to the pre-admission status migrainosus severity. One patient reported mild diarrhea and nausea but was still able to continue the drug for a week. Conclusion: Methylergonovine maleate after 3–5 days of IV DHE infusions may be a feasible treatment strategy for status migrainosus. This approach has the potential to prolonged the benefit of IV DHE and prevent relapse in to status migrainosus. [ABSTRACT FROM AUTHOR]

Objective: To study the efficacy of intraumbilical vein Methylergonovine maleate on duration of third stage of labor.Materials and Methods: Eighty-four term pregnant women undergoing vaginal delivery at Ramathibodi Hospital without risk factors were randomly assigned to receive 1 ml of Methylergonovine maleate (0.2 mg/ml) plus 0.9%NaCl 19 ml (n=42) or 0.9%NaCl 20 ml (n=42) by intraumbilical vein injection within one minute after cord clamping. Placenta was delivered by control cord traction technique. The duration of third stage of labor and side effects at one hour later were analysed.Results: There were no statistically significant difference among 2 groups regarding age, gestational age, parity, birth weight, placental weight and estimated blood loss. The duration of third stage of labor in Methylergonovine maleate group showed no statistically significant difference in compare with 0.9% NaCl group (5.97±3.28 Vs 6.53±4.56 minutes respectively, P>0.05). No side effects were observed in both groups.Conclusions: Intraumbilical vein Methylergonovine maleate had no effected on the duration of third stage of labor.

Methylergonovine (ME) is a semisynthetic ergot alkaloid that is used for the treatment and prophylaxis of postpartum hemorrhage. In recent years, methylergonovine has been effective in the control of refractory headaches and is likely to be employed as chemosensitizers for cancer. However, this alkaloid sometimes causes elevated blood pressure. Therefore, a sensitive and accurate method for the quantification of this drug in biological matrices is necessary. In this study, ME was extracted from 500 μL plasma samples by a liquid–liquid extraction under alkaline conditions and detected using positive multi-reaction-monitoring mode (+MRM) mass spectrometry. The method was validated according to US FDA guidelines and covered a working range from 0.025 to 10 ng/mL with a lower limit of quantification (LLOQ) of 0.025 ng/mL. In conclusion, a rapid, sensitive, selective and accurate quantification by an LC–MS/MS method was developed and successfully applied to a clinical pharmacokinetics study in female volunteers after a single intramuscular injection or oral administration of a 0.2 mg dose of ME maleate. It is suitable for both preclinical and clinical studies on ME. [ABSTRACT FROM AUTHOR]

Neurological deficits associated with methylergometrine have been reported primarily as a result of reversible cerebral vasoconstriction syndromes (RCVS). RCVS are characterized by reversible multifocal vasoconstrictions of the cerebral arteries heralded by acute severe headache with or without neurological deficits. Here, we present the first case of suspected RCVS with transient limb myoclonus following the intravenous administration of methylergometrine during cesarean section. A 31-year-old woman who received slowly infused intravenous methylergometrine during a cesarean section suddenly reported severe occipital headache after 40 min, followed by apnea and unconsciousness for 8 min. A second administration of methylergometrine to treat the weakness of her uterine contractions resulted in a repeated loss of consciousness within minutes and the development of limb myoclonus. No abnormalities were detected by brain computerized tomography, magnetic resonance imaging, and electroencephalogram. She fully recovered spontaneously within 12 h. We consider that the transient limb myoclonus in our patient appeared as a result of RCVS caused by the intravenous administration of methylergometrine. Keywords Limb myoclonus * Methylergometrine * Reversible cerebral vasoconstriction syndrome (RCVS), Introduction Transient neurological deficits, such as headache, seizures, consciousness disturbances, visual disturbances, or muscle weakness, have been reported to be associated with methylergometrine administration [1, 2]. Most such events developed [...]

Abstract This resource is an audiovisual tutorial for pharmacologic management of postpartum hemorrhage. This module was prepared for use in residencies with significant obstetrical training but is appropriate for use by any individual seeking detailed information on pharmacologic management of postpartum hemorrhage. It can be used in conjunction with postpartum hemorrhage simulation, in support of didactic sessions, and as a stand-alone discussion or review of the subject matter. The presentation contains a narrated slide set with embedded summary tables. There is a transcription of all audio narration so that the resource is usable by the hearing impaired. This module was developed as part of a comprehensive blended learning curriculum for teaching the management of postpartum hemorrhage. The full curriculum included seven online modules followed by face-to-face teaching and learning with task trainers and a multidisciplinary simulation case. Project-associated pre- and posttesting demonstrated clear improvement in mastery of material as a result of using this module. All trainees completing the module reported that the module increased their knowledge “moderately” or “to a great extent.” Additionally, all trainees reported that they “agreed” or “strongly agreed” that they would recommend the module to another learner.

Background and Objective: Postpartum hemorrhage is a common obstetric complication and a major cause of maternal mortality. Uterotonic drugs are used to prevent abnormal postpartum hemorrhage. Known uterotonic agents include methylergonovine, oxytocin, and prostaglandins. This study compares the effect of these three agents on prevention of abnormal postpartum hemorrhage. Subjects and Methods: This randomized clinical trial was carried out on 150 pregnant women with singleton pregnancies, live fetuses and without previous medical history, during 2010. Mothers were randomly divided into three groups each comprised of 50 cases. Cases in the first group received 400 µg sublingual misoprostol; the second group, 0.2 mg intramuscular methylergonovine; and the third had 20 units of oxytocin, intravenous infusion in 1 liter ringer solution immediately after delivery of the newborn's anterior shoulder. Descriptive statistics was used to present indices (mean value, standard deviation); t-test and variance analysis was used to compare mean values. Results: The duration of the third stage of labor, hemoglobin fall 24 hours after parturition, and the amount of hemorrhage during third and fourth stages of labor were compared amongst the three aforementioned groups, which yielded no statistically significant difference between them (P > 0.05). Low grade fever (38°C) was observed in two of the cases given misoprostol which subsided following administration of 2-3 liters of crystalloids. No other side effects were seen in the other two groups. Conclusion: Oxytocin, methylergonovine, and misoprostol are equally effective in prevention of postpartum hemorrhage. [ABSTRACT FROM AUTHOR]

Purpose: In order to prevent postpartum hemorrhage in caesarean section under spinal anesthesia, patients routinely receive oxytocin. In this study we compared the efficacy of Methylergonovine and Oxytocin on hemodynamic stability and bleeding amount in caesarean section. Materials and methods: In this randomised controlled trial study, 80 patients candidate for elective caesarean section under spinal anesthesia divided to two groups: 40 patients in control group received oxytocin and 40 ones in case group received methylergonovine. Results: There was no differences between groups in Mean age, baseline hemodynamic values, after spinal anesthesia and recovery (except diastolic blood pressure min 20), time of uterine atony, dizziness; nausea and vomiting. After drug administration (oxytocin and methylergonovine), systolic blood pressure in minutes 1, 10, 15 and diastolic blood pressure in minutes 1, 3, 20 increased in case group statistically more than control group. In control group, heart rate in minutes 1, 5 increased significantly more than the other group. Mean arterial blood pressure in minutes 1, 3, 5, 10, 15 reduced significantly more than in control group. Need to vasoconstrictor drug statistically was less in case group ( p < 0.0001). Conclusion: Methylergonovine induced significantly more hemodynamic stability. Adverse effects were similar between two groups. We recommend the use of methylergonovine in patients with caesarean section under spinal anesthesia because of its hemodynamic stability and low need to vasoconstrictor drugs. [ABSTRACT FROM AUTHOR]