Second-lineSyntometrine (5 IU oxytocin + 500 mcg ergometrine)

Ergometrine / Syntometrine

Ergot alkaloid uterotonic

Second-line uterotonic for PPH — powerful but pressor.

IMSlow IV (rare)

First-line for

PPH not controlled by oxytocin
Active 3rd-stage management in low-risk women (combined)

Mechanism

Direct α-adrenergic + serotonergic action on uterine smooth muscle → sustained tonic contraction.

“HEART” — when ergometrine is wrong

H — Hypertension / pre-eclampsia
E — Eclampsia
A — Arterial disease (IHD, PVD)
R — Raynaud's / vasospasm
T — Twisted (retained placenta — caution)

Dosing

IM: 500 mcg IM (often with 5 IU oxytocin)
IV (emergency): 250–500 mcg slow IV

Contraindications

AbsoluteHypertension, pre-eclampsia, eclampsia
AbsoluteCardiac disease, severe peripheral vascular disease

Side effects

Nausea & vomiting (very common)
Hypertension, headache
Coronary vasospasm, MI (rare)
Bronchospasm

Fetal & maternal notes

• Given AFTER delivery only.
• Trace in breast milk — limit doses; theoretical lactation suppression.

Key interactions

Triptans, other ergots
Avoid
Severe vasospasm — avoid
CYP3A4 inhibitors (macrolides, azoles)
Avoid
↑ ergot toxicity

Clinical pearls

💡 Always check BP before giving — major cause of postnatal hypertensive crisis.
💡 Give antiemetic prophylactically.

Content last reviewed: REPLACE_ME (e.g. 2026-07)

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