Date of Award

2015

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Department Chair

John Cavenagh, MBA, PhD, PA-C

Abstract

Objective: The objective of this selective EBM review is to determine whether or not methylergometrine is more effective than other uterotonic agents in preventing postpartum hemorrhage during the third stage of labor. Study Design: Review of two randomized controlled trials (RCTs) published in 2004 and 2009, and one prospective study published in 2006. Data Sources: Each article used was published in English and found using PubMed and Medline. The studies compared the efficacy of methylergometrine against uterotonic agents, specifically oxytocin and misoprostol. Outcomes Measured: The efficacy of methylergometrine was measured via the incidence of postpartum hemorrhage despite the use of prophylactic medication and adverse effects of medications. Results: Vimala et al (2004) found that methylergometrine and misoprostol were equally effective at decreasing the amount of blood loss [170±42ml vs. 185±56ml; p >0.05], as well as in terms of adverse side effects, specifically nausea [13.3% vs. 6.6%; p >0.05]. Singh et al (2009) found that methylergometrine was less effective compared to oxytocin in reducing the mean blood loss during the third stage of labor [223.48ml vs. 154.73ml; p <0.01]. While Fujimoto et al (2006) also noted that methylergometrine was more likely increase incidences of postpartum hemorrhage than oxytocin [18.6% vs. 7.3%; OR = 0.31], no differences in resultant adverse side effects were found [2.8% vs. 1.2%]. Conclusions: Due to the limitations of the studies with regards to the use of methylergometrine compared to other uterotonic agents, its efficacy over these drugs remains inconclusive. However, methylergometrine was not shown to produce more adverse side effects than standard of care uterotonic agents oxytocin and misoprostol.

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