title: Prophylactic use of ergot alkaloids in the third stage of labour.
abstract: BACKGROUND
  Previous research has shown that the prophylactic use of uterotonic agents in the third stage of labour reduces postpartum blood loss and moderate to severe postpartum haemorrhage. This is one of a series of systematic reviews assessing the effects of prophylactic use of uterotonic drugs - here, prophylactic ergot alkaloids compared with no uterotonic agents, and different regimens of administration of ergot alkaloids.
  
  
  OBJECTIVE
  To determine the effectiveness and safety of prophylactic use of ergot alkaloids in the third stage of labour compared with no uterotonic agents, as well as with different routes or timing of administration for prevention of postpartum haemorrhage.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 December 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 4) and MEDLINE (1966 to December 2006).
  
  
  METHODS
  All randomised or quasi-randomised controlled trials comparing prophylactic ergot alkaloids with no uterotonic agents or comparing different routes or timings of administration of ergot alkaloids in the third stage of labour among women giving birth vaginally.
  
  
  METHODS
  We systematically reviewed the potential studies, considered eligible studies, assessed the validity of each included study and extracted data independently.
  
  
  RESULTS
  We included six studies comparing ergot alkaloids with no uterotonic agents, with a total of 1996 women in ergot alkaloids group and 1945 women in placebo or no treatment group. The use of injected ergot alkaloids in the third stage of labour significantly decreased mean blood loss (weighted mean difference -83.03 ml, 95% confidence interval (CI) -99.39 to -66.66 ml) and postpartum haemorrhage of at least 500 ml (relative risk (RR) 0.38, 95% CI 0.21 to 0.69). 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. No maternal adverse effects were reported. There were no included trials that compared different administration regimens of ergot alkaloids.
  
  
  CONCLUSIONS
  Prophylactic intramuscular or intravenous injections of ergot alkaloids are effective in reducing blood loss and postpartum haemorrhage, but adverse effects include vomiting, elevation of blood pressure and pain after birth requiring analgesia, particularly with the intravenous route of administration.
authors: Prince of Songkla University, Department of Obstetrics and Gynecology, Faculty of Medicine, Hat Yai, Songkhla, Thailand, 90110. ltippawa@hotmail.com
authors: T
authors: T
authors: Liabsuetrakul
authors: T
authors: T
authors: Choobun
authors: K
authors: K
authors: Peeyananjarassri
authors: Q M
authors: QM
authors: Islam
mesh_terms: D004876:Ergot Alkaloids / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007275:Injections, Intravenous; D007749:Labor Stage, Third; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic
chemical_list: D004876:Ergot Alkaloids