section name header

Evidence summaries

Ergot Alkaloids in the Third Stage of Labour

Prophylactic intramuscular or intravenous injections of ergot alkaloids appear to be effective in reducing blood loss and postpartum haemorrhage, but adverse effects include vomiting, elevation of blood pressure and pain after birth requiring analgesia. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 8 studies with a total of 4009 subjects. The use of injected ergot alkaloids in the third stage of labour significantly decreased mean blood loss (weighted mean difference -80.52 ml, 95% confidence interval (CI) -96.39 to -64.656.66 ml; 3 trials, n=2718) and postpartum haemorrhage of at least 500 ml (relative risk (RR) 0.52, 95% CI 0.28 to 0.94; 5 trials, n=3708, I²=83), and increased maternal haemoglobin concentration (g/dL) at 24 to 48 hours postpartum (MD 0.50 g/dL, 95% CI 0.38 to 0.62; 1 trial, n=1429). The risk of retained placenta or manual removal of the placenta, or both, were inconsistent. Ergot alkaloids increased the risk of vomiting (RR 11.81, 95% CI 1.78 to 78.28), elevation of blood pressure (RR 2.60, 95% CI 1.03 to 6.57) and pain after birth requiring analgesia (RR 2.53, 95% CI 1.34 to 4.78). One study compared oral ergometrine with placebo and showed no significant benefit of ergometrine over placebo. There were no included trials that compared different administration regimens of ergot alkaloids.

Comment: The quality of evidence is downgraded by study limitations.

    References

    • Liabsuetrakul T, Choobun T, Peeyananjarassri K, Islam QM. Prophylactic use of ergot alkaloids in the third stage of labour. Cochrane Database Syst Rev 2007;(2):CD005456 [Last assessed as up-to-date: 22 August 2011]. [PubMed]

Primary/Secondary Keywords