Drugs List

Therapeutic Indications

Uses

Labour - management during third stage
Post partum haemorrhage

Administration

Administration by intramuscular injection is the recommended route.

Intravenous administration by slow injection is possible, but should be limited to use only in cases of severe haemorrhage due to uterine atony.

Contraindications

Sepsis
Breastfeeding
Eclampsia
Long QT syndrome
Porphyria
Pre-eclampsia
Pregnancy
Severe cardiac disorder
Severe hepatic impairment
Severe hypertension
Severe renal impairment
Torsade de pointes
Vascular disorder

Precautions and Warnings

Family history of long QT syndrome
Cardiac disorder
Electrolyte imbalance
Hepatic impairment
History of torsade de pointes
Hypertension
Renal impairment

Correct electrolyte disorders before treatment
Consider monitoring ECG in patients at risk of QT prolongation
Monitor serum electrolytes
Advise patient grapefruit products may increase plasma level

In postpartum haemorrhage, if bleeding is not arrested by ergometrine and oxytocin injection, exclude the presence of retained placental fragment, soft tissue injury such as cervical or vaginal laceration or of clotting defects before giving a further dose.

Pregnancy and Lactation

Pregnancy

Ergometrine with oxytocin is contraindicated in pregnancy.

Ergometrine and oxytocin is used for the management of the third stage of labour and postpartum haemorrhage and cause tonic uterine contractions. Ergometrine and oxytocin injection is contraindicated during pregnancy because of the risk of foetal hypoxia and death caused by its uterine effect.

Accidental use during the 1st trimester does not automatically require termination of the pregnancy. Detailed ultrasound scanning can exclude morphologic developmental disorders.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Ergometrine with oxytocin is contraindicated in breastfeeding.

Ergometrine with oxytocin injection is indicated only for the management of the third stage of labour and for postpartum haemorrhage. There is no indication for its use during breastfeeding.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Anaphylactoid-like reaction
Bradycardia
Cardiac arrhythmias
Chest pain
Collapse
Coronary vasospasm
Dizziness
Dyspnoea
Headache
Hypertension (transient)
Hypotension
Myocardial infarction
Nausea
Rash
Shock
Vomiting

Presentation

Injection containing ergometrine and oxytocin

Drugs List

Therapeutic Indications

Uses

Labour - management during third stage
Post partum haemorrhage

Dosage

Adults

Additional Dosage Information

Administration

Administration by intramuscular injection is the recommended route.

Intravenous administration by slow injection is possible, but should be limited to use only in cases of severe haemorrhage due to uterine atony.

Contraindications

Sepsis
Breastfeeding
Eclampsia
Long QT syndrome
Porphyria
Pre-eclampsia
Pregnancy
Severe cardiac disorder
Severe hepatic impairment
Severe hypertension
Severe renal impairment
Torsade de pointes
Vascular disorder

Precautions and Warnings

Family history of long QT syndrome
Cardiac disorder
Electrolyte imbalance
Hepatic impairment
History of torsade de pointes
Hypertension
Renal impairment

Correct electrolyte disorders before treatment
Consider monitoring ECG in patients at risk of QT prolongation
Monitor serum electrolytes
Advise patient grapefruit products may increase plasma level

In postpartum haemorrhage, if bleeding is not arrested by ergometrine and oxytocin injection, exclude the presence of retained placental fragment, soft tissue injury such as cervical or vaginal laceration or of clotting defects before giving a further dose.

Pregnancy and Lactation

Pregnancy

Ergometrine with oxytocin is contraindicated in pregnancy.

Ergometrine and oxytocin is used for the management of the third stage of labour and postpartum haemorrhage and cause tonic uterine contractions. Ergometrine and oxytocin injection is contraindicated during pregnancy because of the risk of foetal hypoxia and death caused by its uterine effect.

Accidental use during the 1st trimester does not automatically require termination of the pregnancy. Detailed ultrasound scanning can exclude morphologic developmental disorders.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Ergometrine with oxytocin is contraindicated in breastfeeding.

Ergometrine with oxytocin injection is indicated only for the management of the third stage of labour and for postpartum haemorrhage. There is no indication for its use during breastfeeding.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Anaphylactoid-like reaction
Bradycardia
Cardiac arrhythmias
Chest pain
Collapse
Coronary vasospasm
Dizziness
Dyspnoea
Headache
Hypertension (transient)
Hypotension
Myocardial infarction
Nausea
Rash
Shock
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: April 2016

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Joint Formulary Committee. British National Formulary. 71st ed. London: BMJ Group and Pharmaceutical Press; 2016.

Summary of Product Characteristics: Syntometrine Ampoules. Alliance Pharmaceuticals. Revised January 2016.

The Welsh Medicines Information Centre (WMIC) - Porphyria Information Service.
Available at: https://www.wmic.wales.nhs.uk/porphyria_info.php
Last revised: May 2015
Last accessed: 15 April 2016