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Uterotonic (Ergot Alkaloid) Pregnancy: Postpartum use only

Ergometrine

Brand names: Syntometrine (combined with oxytocin), Ergometrine Maleate

Adult dose

Dose: 500 micrograms IM (as Syntometrine: oxytocin 5 units + ergometrine 500mcg IM)
Route: IM
Frequency: Single dose
Active management of third stage: Syntometrine IM at delivery of anterior shoulder. If IV needed: 250 mcg ergometrine IV slowly.

Clinical pearls

  • AVOID in hypertension — causes profound vasoconstriction and hypertensive crisis
  • Check BP before administration — if systolic >140 or diastolic >90, use oxytocin alone
  • Syntometrine: preferred over oxytocin alone for third stage in low BP, no contraindications
  • Nausea and vomiting common — warn patient; antiemetic may be needed

Contraindications

  • Hypertension (pre-eclampsia, eclampsia, chronic HTN)
  • Cardiac disease
  • Peripheral vascular disease
  • Hepatic or renal impairment

Side effects

  • Hypertension
  • Nausea and vomiting
  • Vasoconstriction
  • Vasospasm (coronary, peripheral)

Interactions

  • Triptans — increased vasoconstriction risk
  • Macrolide antibiotics (erythromycin) — increased ergot levels
  • Beta-blockers — additive vasoconstriction

Monitoring

  • Blood pressure (before and after)
  • Uterine tone
  • Blood loss

Reference: RCOG Active Management of Third Stage of Labour; BNF. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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