Multimodal Oxytocin and Methylergonovine Prophylaxis Explored for Postpartum Hemorrhage Prevention in Laboring Cesarean Patients

Postpartum hemorrhage (PPH) remains a critical cause of maternal morbidity and mortality globally, with uterine atony accounting for 70-80% of cases. Risk factors like prolonged and augmented labor significantly increase PPH incidence. While oxytocin is the first-line therapy for atony prevention and treatment, prior exposure can lead to oxytocin receptor desensitization and downregulation, diminishing its efficacy. This highlights a crucial gap in current preventative strategies, particularly for high-risk patients. Optimizing prophylactic practices is essential to improve outcomes and reduce the need for emergency interventions.

Investigators are examining multimodal prophylactic uterotonics in laboring patients requiring a cesarean section, a group at increased risk for PPH. The intervention involves administering standard oxytocin alongside methylergonovine at delivery. The primary outcome will assess the need for additional uterotonic agents (Methylergonovine, Carboprost, Misoprostol) post-delivery. Secondary outcomes include PPH incidence (quantitative blood loss >1 liter), uterine tone four minutes post-placenta, hemoglobin changes, blood transfusion needs, ICU admission, and uterine infection (endometritis).