Skip to content
ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Combined uterotonic (ergometrine + oxytocin) Pregnancy: Section 4.6: 'Ergometrine has potent uterotonic activity. Therefore Syntometrine is contraindicated during pregnancy and during induction of labour; first stage labour and second stage labour prior to the delivery of the anterior shoulder. In breech presentation and other abnormal presentations, Syntometrine should not be given before delivery of the child is completed, and in multiple births not before the last child has been delivered. Breast-feeding - Ergometrine derivatives are excreted in breast milk but in unknown amounts. There is no specific data available for elimination of ergometrine partitioned in breast-milk. Ergometrine can inhibit prolactin secretion and in turn can suppress lactation, so its repeated use should be avoided.'

Ergometrine with oxytocin

Brand names: Syntometrine

A fixed combination of ergometrine and oxytocin (commonly known as Syntometrine) given to promote uterine contraction in active management of the third stage of labour and to control postpartum haemorrhage.

Adult dose

Dose: Active management of the third stage of labour: 1 ml (500 micrograms ergometrine maleate + 5 IU oxytocin) by intramuscular injection after delivery of the anterior shoulder, or at the latest immediately after delivery of the child. Prevention and treatment of postpartum haemorrhage: 1 ml by intramuscular injection following expulsion of the placenta, or when bleeding occurs.
Route: Intramuscular
Frequency: Single 1 ml injection for each indication as printed (the SPC gives no repeat-dose interval)
Strength (SPC section 2): each 1 ml ampoule contains 500 micrograms ergometrine maleate and 5 IU oxytocin. Syntometrine should be used under medical supervision only (section 4.2). Expulsion of the placenta, normally separated by the first strong uterine contraction, should be assisted by controlled cord traction (section 4.2). Intramuscular injection is the recommended route; intravenous administration (0.5 to 1 mL by slow injection) is possible but should be limited to use only in cases of severe haemorrhage due to uterine atony (section 4.2 'Method of administration'). SCOPE: obstetric use only - contraindicated in pregnancy and labour (induction of labour, first stage and second stage labour prior to delivery of the anterior shoulder) due to the risk of uterine hypertonus and associated foetal complications (section 4.3). In breech and other abnormal presentations do not give until after delivery of the child, and in multiple births not until the last child has been delivered (section 4.4). Section 4.4 of the retrieved bundle text is cut off mid-sentence and is not completed here. Paediatric population: no data are available (section 4.2); elderly: not applicable.

Dose adjustments

Renal

SPC 4.2: no studies have been performed in renal impairment; considering the metabolic pathway of ergometrine and oxytocin, use is contraindicated in severe renal impairment and caution is required in mild or moderate renal impairment (sections 4.2, 4.3).

Hepatic

SPC 4.2: no studies have been performed in hepatic impairment; considering the metabolic pathway of ergometrine and oxytocin, use is contraindicated in severe hepatic impairment and caution is required in mild or moderate hepatic impairment (sections 4.2, 4.3).

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via MHRA Products — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substances or to any of the excipients (section 4.3)
  • Pregnancy and labour (induction of labour, first stage labour and second stage labour prior to the delivery of the anterior shoulder) due to the risk of uterine hypertonus and associated foetal complications (section 4.3)
  • Primary or secondary uterine inertia (section 4.3)
  • Severe hypertension, pre-eclampsia, eclampsia (section 4.3)
  • Severe cardiac disorders (section 4.3)
  • Severe hepatic or renal impairment (section 4.3)
  • Occlusive vascular disease (section 4.3)
  • Sepsis (section 4.3)

Side effects

  • Frequency not known for all reactions (post-approval spontaneous reports) (section 4.8)
  • Anaphylactic/anaphylactoid reactions associated with dyspnoea, hypotension, collapse or shock (section 4.8)
  • Headache, dizziness (section 4.8)
  • Myocardial infarction, coronary arteriospasm, bradycardia, cardiac arrhythmias, chest pain (section 4.8)
  • Hypertension (section 4.8)
  • Vomiting, nausea, abdominal pain (section 4.8)
  • Rash, angioedema (section 4.8)

Interactions

  • Vasoconstrictors/sympathomimetics, even those contained in local anaesthetics - may enhance vasopressor effects; concomitant use not recommended (section 4.5)
  • Prostaglandins and their analogues - potentiate the uterine action of each other; concomitant use not recommended (section 4.5)
  • Strong CYP3A4 inhibitors (protease inhibitors, macrolide antibiotics, azole antifungals, quinolones, HIV protease or reverse transcriptase inhibitors) - might raise ergot levels and lead to ergotism; combined use should be avoided (section 4.5)
  • Other ergot alkaloids/derivatives (e.g. methysergide) - can increase the risk of severe and persistent spasm of major arteries (section 4.5)
  • Triptans - additive vasoconstriction (section 4.5)
  • Beta-blockers - may enhance the vasoconstrictive action of ergot alkaloids (section 4.5)
  • Glyceryl trinitrate and other antianginal drugs - effect expected to be reduced by ergometrine vasoconstriction (section 4.5)
  • Drugs prolonging the QT interval - oxytocin potentially arrhythmogenic, particularly with other torsades de pointes risk factors or long QT syndrome (section 4.5)
  • Inhalation anaesthetics (e.g. halothane, sevoflurane, desflurane, isoflurane) - relax the uterus and may diminish the uterotonic effect (section 4.5)
  • CYP3A4 inducers (e.g. nevirapine, rifampicin) - may reduce the clinical effect of ergometrine (section 4.5)

Monitoring

  • Active management of the third stage of labour requires expert obstetric supervision (section 4.4)
  • Use under medical supervision only (section 4.2)

Clinical monograph

How it works

Oxytocin produces rapid rhythmic uterine contractions while ergometrine adds a sustained tonic contraction, combining fast onset with prolonged uterine action to limit bleeding.

Prescribing in practice

  • The ergometrine component makes it contraindicated in pre-eclampsia, eclampsia, hypertension and severe cardiac disease, where oxytocin alone is preferred.
  • Give only after delivery of the baby (and not during the first or second stage), as it is unsuitable for induction or augmentation.
  • Nausea and vomiting are more common than with oxytocin alone owing to the ergometrine component.

Monitoring

Monitor blood pressure, uterine tone and ongoing blood loss following administration.

Counselling the patient

  • Feeling sick or vomiting can occur shortly after the injection.
  • It is given by the maternity team to help the womb contract and reduce bleeding after birth.
  • Share any history of high blood pressure or heart problems beforehand.

Evidence & guidelines

Combined ergometrine-oxytocin is recognised in RCOG guidance as an option for active management of the third stage where there are no contraindications to ergometrine.

Reference: RCOG GTG 52; NICE NG235 Intrapartum care; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways