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The following is a summary of “Second-Line Uterotonics for Uterine Atony: A Randomized Controlled Trial,” published in the September 2024 issue of Obstetrics and Gynecology by Cole et al.  

Uterine atony is a leading cause of postpartum hemorrhage, necessitating effective uterotonics for management.  

Researchers conducted a prospective study to evaluate the efficacy of methylergonovine and carboprost in patients with uterine atony.  

They conducted a double-blind, randomized trial at 2 large academic perinatal centers involving patients undergoing nonemergency cesarean delivery with uterine atony refractory to oxytocin (n=100). Participants received either intramuscular methylergonovine or carboprost at the time of diagnosis. The primary outcome was uterine tone measured on a 0–10 numeric rating scale at 10 minutes post-administration, rated by blinded obstetricians. Secondary outcomes included additional uterotonics, interventions for uterine atony, quantitative blood loss, transfusion, and postpartum complications (P<.05).  

The results showed that the mean uterine tone scores were 7.3±1.7 after methylergonovine and 7.6±2.1 after carboprost, with an adjusted difference of −0.1 (95% CI, −0.8 to 0.6, P=.76). Additional second-line uterotonics were required in 30% of the methylergonovine group and 34% of the carboprost group (aOR 0.72, 95% CI, 0.27–1.89, P=.505). The geometric mean quantitative blood loss was 756 mL (95% CI, 636–898) for methylergonovine and 708 mL (95% CI, 619–810) for carboprost (adjusted ratio of geometric means 1.06, 95% CI, 0.86–1.31, P=.588).  

They concluded that methylergonovine and carboprost had no significant differences in uterine tone scores for refractory uterine atony, suggesting either agent was a viable option.  

Source: journals.lww.com/greenjournal/fulltext/9900/second_line_uterotonics_for_uterine_atony__a.1158.aspx