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The Optimal Concentration of tvtethergine 0.2 mg Intravenous to Strong

Contraction of Uterus and Reduce Complication During Cesarean Section

gruur 5tt6r:nYnd* ilu.u. Sumana Watcharadirekrat* B.N.S.

rrfiuvrd fiqlryr,r:rntitti** t,.t.u. Thanin Pinyopornpanit*x M.D.

n{runr:vtutilta* Nursing Department*

ncirusru?frqdivrsr** Department of anesthesiology**i ss

I:svrt ruraaa:tnirJ:vmYnd sawanpracharak Hospitalvvd{sffioufl:aa::ri Nakhon Sawan

J. v Jfl2::nil:uTllflul?ufl'l: Sawanpracharak Medical Journal

flfi o qliufi s ffuursru-fuatnru zmz VoLo Noa SeptemberDecember 2ooe

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Abstract

Objective

Ad,?ol:6u[[asd:lJq

oovgr't m fl a,q

Setting

Design

To study the optimal diluted concentration of Methergine in reducing

side effect and prevention of postpartum haemorrhage in cesarean

section patient.

Obstetrics operative rooms of Sawanpracharak Hospital

Clinical randomized controlled trial

axlill{r,{ufitilxllsdillo{ methergine o.z fia6nir fifiqr{rilr{yaonra'osr't'r rfl'odrl#r,nanynio6':ruasaonrasun:ndouludrl:or.ir6'onaonrr.:fl #r#o{

The Ootimal Concentation of Metlergine o.z mg Intravenous to Strong Contraction of2OS Uterus md Reduce complication puing cesrem section tld O ofld 3 n.cl.-fi.n. 2552

Subiects : 200 elective cesarean section patients in Sawanpracharak Hospital between

November 2008 to March 2009, gesiational age 37 weeks or greater,lT-36

years of age and physical status l-ll were enrolled into the study. The

patients were randomized into four groups : Methergine no dilution

(n = 50) dilute to 5 rc. (n = 50) dilute to 10 cc. (n = 50) and dilute to 20 cc.

(n = 50).

Method I we recorded demographic data, heart rate and arterial blood pressure,

incidence of chest pain, nausea and vomiting, headache and uterine

contraction. Statistical difference between groups with ANovA and exact

probability test. correlation analysis between dilution of Methergine and

incidence of nausea, vomiting, headache and uterine contraction using

Spearman's rank correlation.

i In all four groups, mean age was 21.1-26.6 years old, mean body weight

was 65.1-70.9 kg., mean height was 156.2-160.0 cm. and mean gestational

age was 38.3-38.7 weeks. The indication for surgery is cephalopelvic

disproportion (cPD) (54.0 - 66.0%). Mean duration of surgery was g7.g-40.2

min. Mean time of Methergine administered intraoperative was between

13.1-15.1 min. Mean blood loss was 426-422 ml., and mean amount

ephedrine administered was 8.5-10.1 mg. The most incidence of chest

pain symptom was found in dilute to 20 cc. group (16.0%). ln no dilution

group, there is no incidence of nausea and vomiting (79.o"/") while in dilute

to 20 cc group 24.o"/" of patients vomit. Level t headache occurred mosfly

in no dilution group (98.0%). All 4 groups had strong uterine contraction

(e6.0-100.0%)

Results

Conclusion I There are no difference in side effects and uterine contraction among

different dilution of Methergine.

Key words : methergines, nausea and vomiting, chest pain, headache, uterine

contraction

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e u o i ; 3mTtnulo{fi?Larflaury{rJ?rua1n 90.1 13.2

odfiil:vrurru o-1 o u1fi r:r6.,:lru'ird'n:1n1:9 vO r I v

rnu?a{?1? tanofl I nna{aunafl nfl1:r.,r'rFrFr

finr:6nurlruirnT :lfr methergine

^' ua d 6 9 r{ rd

aslyt 3J au n n1Tilz a{ fl 1:tau nu1 a n un L3J elq

ruarianr:rfi nR1xrfi-?tatr n uda n(8'1') uda.,:ornd y & a qy q u

a1fl1:LAUfi UlAnUUtfl Ft LnA',lfl ?1A1 UilAAfl [tU

n1T6uza.,rfi aa nnfrJa1 n n1:lfr methergineA A a Y, A yau

fi :a tn na1 fl fl 1:rhlT.0 peritoneu m cr.,t 6:11 Lfi Et1

e ,; - - - .i< , 4 " d "oyn: lilll,UUulltlltJledilflO.l methergine 0.2 ilaan:tu TAntt'lflll},lA0StAonnt l?tOyllll{ilOAn?tfltfln:

rlasasfl "r1rum:n4oulupXrhur.irsiennoqmt{ildtf'o,l

The Optimal Concenkation of Methergine 0.2 mg Intravenous to Strong Contraction of209 Uterus md Reduce Complication Dwing Cesrem Section ufl 6 auuvr 3 n.u.-fl.n. 2552

methergine rirlfrfi nT :m orfn rirratd d A & ur a

fi fl a n Laan ilfl 1:tyl8Jltu?a{n?1ilau [nfi Fl Ltny

finfint:ililrunrrrYav d a

nfuBzu?a fl fl a?ou n6u u't u tl?\m g tqa t.tqqa .l 3 uo ett a a&r fl 1 : rT{ 8J?rU? O { Ft'11 }.t Ft U LU 6t3J O{

ry il X U A.l il

a1 n'r:il? Fr 6:us('o) uri nr:finurdnrr ru riu

u "{

v 9o I d.nnnfl:tu r{a1u?fl n1T[i.]ylU1u1a6l']::nil:!fnq

Iafi n frr.h g ri auf,r.,: n',rfi rl a a n n1:ni1 rior

v d a v y ae dTfl U LLAB n6U6{UUTt1 {U8fl8ifl ?1?14U1.,:1U? d6U 6II q { ouEi o 9 o A ten au 6u1 Fr lfi il1 n1: Flnul uasI r.t 8l Lt]t:fl a 3J aqo{q

n1:ri1fi u Ft:vu v r? a1'[u nr:d n arlfrI v V , 6, v o v o a vy

uvir n u n.: 4 n 6i il a1 a av rf I u{o dr nr-o ri'L[r4 fi d r EJqq

lfiiu metnergine o.z fiafiniu nrEl'lu:vErvd I u oOY a I d

[?a1 1 ulYtLYtlflU Tt1 1fifl1:tnnA1n1:?1{LnU{{ ' t e \4Y a I d aLSJttnfl Fl1{flltLFt o{alaQvna{ilfl1:ila1:6u1

uil 6 uu url a{:sssr?a1lu nr:lfr fl rtfi ei

fl ofl aun6u nru8:m::ru ra.,:daorT :uri i#rufiqq

i' o u a Y1'{g1U1A ilZ?Um1n1:Uuilnzoiln F|nonfl1:

-q

dnur

fi:ilq

n1:t6aa1{ methergine firaAr:asa1 Hil3il1 rx un n ri1\: ri'ulilrir'lfr a1 n1Tfl1{

AVVrVtFl tl{ tLAvr{ A fl 1:fi ,lTFl Fl?? O\: 3J n A fl Un fl n1{ nU

tonm:d]{6{'1. Chau-ln W. Anesthesia for postpartum hemorrhage. SMJ 2550; 22: 297-309.

2. Li XF, Fortney JA, Koteichuck M, Glover LH. The postpartum period: the key to

maternal mortality. lnt J Gynecol Obstet 1996; b4: 1-10.

Van Dongen ow, De Groot AN. History of ergot alkaloids form ergotism to

ergometrine. Eur Obstst Gynecol Repord Biol 1995; 60: '109-16.

Huh w, chelmow D, Malone FD, A randomized, double-blinded, placebo controlled

trial of oxytocin at the beginning versus theend of the third stage of labor for

preventation of postpartum hemorrhage. Am J obstet Gynecol 2oo2;182 1go-2.

Hofmey GL, Walraven G, Glmezoglu AM, Maholwana B, Alfirevic Z, yillar J.

Misoprostol to treat postpartum hemorrhage: a systemic review. Br J Obstet Gynecol

2005; 112:547-53.

3.

5.

€, u (612:TnilTtfllTnUt?f,6t1T qrur 5r:6rrnYsni, rrfiuni hqflqu:lnfimi 210

normal labour. Journal of obstetrics and Gynecology of British Empire 1951; 58:

388-97.

7. De Groot AN. The role of oral (methyl)ergometrine in the prevention of postpartum

haemorrhage. Eur Obstst Gynecol Repord Biol 1996; 69: 31-6.

8. Svanstrom MC, Biber B, Hanes M, Johansson G, Naslund U, Balfors EM. Signs of

myocardial ischemia after injection of o4ytocin: a randomized double-blind comparsion

of oxytocin and methylergometrine during caesarean section. Br J Anesth 2008;

'100: 683-9.

9. Zelop CM, Harlow BL, Frigoletto FD Jr, Safon LE, Salfzman DH. Emergency

peripartum hysterectomy. Am J obstet gynecol 1993; 168: 1443-8.'10. Juhani T, Hannele H. Complication during spinal anesthesia for cesarean delivery : a

clinical report of one year's experience.Reg Anesth 1993; 18: 128-3'1.

't1. Datta S, Alper MH, Ostheimer GW, Weiss JB. Method of ephedrine administration

and nausea and hypotension during spinal anesthesia during caesarean section.

Anesthsiology 1982; 56: 68-70.'12. Hong JY, Oh Jl. Dose methergine aggravate chest symptom and/or eletrocardiographic

changes during cesarean delivery under spinal anesthesia. Korean J Anasthesiol

2005; 48:15-20.

13. Lussos SA, Bader AM, Thornhill ML, Datta S. The antiemetic efficacy and safety of

prophylactic metoclopramide for elective mesarean deliveryduring spinal anesthesia.

Reg Anesth 1992; 17:126-30.

14. Brucker MC, Management of the third stage of labor: an evidence.based approach.

Journal of midwifery and Womena Health 2000; 46: 381-92.

211

e I ) A- y a . i "qefl'lllJllj:JUUlltt4UlYfl:J10{ metiergine 0.2 ilaafl:il TAnlflllll{flnOnlAOnnl tflOllll}ruAqnYO:Oql'l

luaeaaRl'rvuvr:frdol]1urhl:orirdonaoovrliyrirfloiThe Optimal Concentration of Meth".gn"t.z mg Inaavenous to Strong Contraction of

Uterus and Reduce Complication During Cestrm S@tion uYr 6 ouuvr 3 n_s.-fi.n. 2552

j e X yi A rA o I vFl1fl{71 1 flAilAvIUflU?A\:4U?Un{n::f,in8J1TUfl1:rJlnnnAOa

n1:t6oa1.: metherginIaailno 1cc 5cc 10 cc

mean(SD) mean(SD) mean(SD) mean(SD)

20 cc P value

alrl(u)Y-

u1fiun(nn.)

druq.:1tru.1

alElnrrri(#iln114')u ,X t v !frori.:fi nr:air n"'n nu 1ta aav1

CPD

Previous cesarean section

Breech presentation

25.e(5.3)

68.8(12.6)

156.2(6.2)

38.3(1 .1)

27(54.0)

19(38,0)

4(8.0)

26.6(7.1)

68.e(11.2)

157.3(6.1)

38.7(1.4)

28(56.0)

16(32.0)

6(12.0)

25.1(5.7)

70.e(11.3)

158.1 (7.2)

38.4(1.7)

31(62.0)

18(36.0)

1(2.0)

25.1(5.0) 0.487

65.1(10.6) 0.088

160.0(6.1) 0.206

38.6(1.0) 0.370

0.358

33(66.0)

16(32,0)

1(2.0)

otm1{fi 2 {aruaza.ooidrs:rfl'ir.Jnr:r.irrinsq

v?a3JA{

n1:t6oa1{ methergin

1cc 5cc 10 cc 20 cc P value

mean(SD) mean(SD) mean(SD) mean(SD)

TsEtsr? a1 n1:ilr rirr 1urfi ;

t?n1fi An methergine(urfi)a Aa

u:sJlrUrnAnmrdu(ila.)

Ephedrine fltfiiu(r,n.)

37.4(7.1)

15.1 (3.4)

470(331.5)

10.0(8.6)

40.2(9.4)

14.3(3.7)

426(179.6)

8.5(7.2)

38.0(11.7)

14.5(4.1)

430(258.1)

10.1 (e.3)

37.3(7.8) 0.377

13.1 (3.1) 0.387

472(322.2) 0.756

8.e(8.3) 0.770

d, i dd?::nil:vt'l:fl1*t?t6l1l qruur 5r:6r:n5nri, rrfiunf fiq.Isuu:urfird 212j v a i o vn I v y y va

n1:1.1fi 3 a1n1:{1{rEa.:filryuLurirhar.irdnnaanml{fifirfra.,:ua-.,:fin methergine o.e fiafiniLt

v?o3Jn

$

n1:tAOA1{ nietherginP value

1cc 5cc 20 cc

druruliaanrl,iruru15aflas)'iruruliaunrl,irurulfaaavl

10 cc

d9taufiu1afl

) qv d

nautdalLaEru

hifrarnr:A uv ,q ' d

nau LdLrn Lil01raEru

arvd or rusa r urihiar 16 uu

a1LAflU

rhnfr:us_)

TrnilYr 1

z*iluS z_)

:YFIUYI 3

n1:fiFlinn-x?o{rJnnfl

(contraction)

no

mild

moderate

strong

4(8.0)

3e(78.0)

5(10.0)

1(2.0)

5(10.0)

4e(e8.0)

1(2.0)

0

0

0

3(6.0)

47(94.O)

4(8.0)

2e(58.0)

14(28.0)

0

7(14.0)

44(88.0)

5(10.0)

1(2.0)

0

0

0

50(100.0)

4(8.0)

37(74.0)

4(8.0)

0

e(18.0)

44(88.0)

4(8.0)

2(4.0)

0

0

1(2.0)

4e(e8.0)

8(16.0)

2e(58.0)

e(18.0)

0

12(24.0)

46(e2.0)

2(4.0)

2(4.0)

0

0

1(2.0)

4e(e8.0)

O.4BB

0.140

0.847

0.240

Y ! 4 - )a y a " n .oyfllllJltutulltlrrJlsdtJtoi methergine 0.2 ilAAn:il flnot,ii'r11t.ll1nofilAoqnt rilOiltlriUoenflsinnl

,h" op,t,d ",i::;:all;llilffi;Y-.1HTl::l}:T'ffis con,rac,ion ofd..j u A213 uterus md Reduce Complication Duing cesrem sction ilYi 6 auuYt 3 ft.u.-fi.n. 2552

n:\:/U1Yl

100

95

90

85

80

75

70

- no dilute

- dilute 5cc

- dilute 1Occ

- dilute 20cc

0 1 3 5 7 I 11 13 1520 25 30 35 40 u1fi

,i ,i , v u6:1lTr 1 fl1:rilAUUrLlla{fl1:tFtU?A{fi?[Aq

d?T:d'il:v{1inr$r':tAr: qruur Strhr:nYnri, rrfiund iqflqil:ilrfiffi 214

fiafirrun:il:avr

140

120

100-Ps

no dilute

-Ps dilute 5cc

-Ps dilute 10cc

-Ps dilute 20cc

-Pd no dilute

-Pd dilute 5cc

-Pd dilute 10cc

-Pd dilute 20cc

:rlfi z n1:1il6fl ulurla.:nmrud'ulafi n

ps = Tsriun?rrun-ulafin zruvil-r'lqfiuFir

Pd = :striuntrruoiulafin zruvil-xtanaluFi?