Oral Plenary Session 2 - Fellows Plenary
Helen B. Gomez Slagle, MD
Clinical Fellow
Columbia University Irving Medical Center
New York, New York, United States
Shai Bejerano, MS
Data Analyst
Columbia University Medical Center
New York, New York, United States
Russell S. Miller, MD (he/him/his)
Sloane Hospital for Women Associate Professor of Prenatal Pediatrics (in Obstetrics and Gynecology)
Columbia University Medical Center
New York, New York, United States
Dena Goffman, MD (she/her/hers)
Professor, Women's Health in Obstetrics & Gynecology; Vice Chair, Quality & Patient Safety
Columbia University Medical Center
New York, New York, United States
Mary E. D'Alton, MD
Obstetrician and Gynecologist-in-Chief
Willard C. Rappleye Professor and Chair
Columbia University Medical Center
New York, New York, United States
Mirella Mourad, MD
Assistant Professor
Columbia University Medical Center
New York, New York, United States
To evaluate whether prophylactic administration of intramuscular (IM) methylergonovine after cord clamping reduces blood loss during cesarean delivery (CD) in twin pregnancies.
Study Design:
This single-center randomized placebo-controlled triple-blinded trial compared the effects on blood loss at CD of IM methylergonovine versus saline placebo control. Pregnant individuals with twin gestations at ³34 weeks of gestation undergoing planned CD were enrolled. Methylergonovine or saline placebo was administered immediately after umbilical cord clamping of the second twin in addition to standard care with oxytocin. The primary outcome was change in maternal hemoglobin (Hgb) level from preoperative to postoperative day 1 (POD 1). We planned to enroll 66 patients to detect a standard deviation (SD) greater drop in postoperative maternal Hgb, assuming -1.40 (0.83) g/dL Hgb difference in planned CDs (90% power, alpha 0.05). Pearson chi-square, or Fisher’s exact test, and Wilcoxon rank-sum with intent-to-treat principles were performed as appropriate.
Results: From February 2023 through March 2024, 77 patients were eligible and 66 participated. There were no demographic differences between methylergonovine and placebo groups. Median gestational age at delivery was 37 weeks for both groups. Mean Hgb drop at POD 1 was 1.1 g/dL (SD 0.7 g/dL) for methylergonovine and 2.1 g/dL (SD 0.9 g/dL) for placebo (p< 0.001). Median quantitative blood loss was significantly lower in patients receiving prophylactic methylergonovine (891cc versus 1017cc, p=0.003). Postpartum hemorrhage rates were lower in the methylergonovine group (18.2% vs 54.5%, p=0.002). There were 7 cases of unblinding due to hemorrhage in the placebo group compared to no cases in the methylergonovine group (p=0.01); unblinded subjects received methylergonovine.
Conclusion: Prophylactic IM methylergonovine administered during twin CD after umbilical cord clamping significantly reduced intraoperative blood loss and hemoglobin drop at POD 1. These data support further study of methylergonovine as a preventative treatment strategy at the time of twin CD.
