Prophylactic Use of Oxytocin Combined with Ergometrine versus Oxytocin Alone for Postpartum Hemorrhage Prevention during Twin Vaginal Deliveries

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 447–458

DOI: 10.46882/2026/IJOG/000518

Original Research Article

Title: Prophylactic Use of Oxytocin Combined with Ergometrine versus Oxytocin Alone for Postpartum Hemorrhage Prevention during Twin Vaginal Deliveries

Names of Authors: Emeka J. Obi¹, Funmilayo R. Adeyemi², Zainab H. Dogara¹

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
² Maternal Health Division, Federal Ministry of Health, Abuja, Nigeria

Abstract:
Twin vaginal births carry a heightened risk of uterine atony and subsequent postpartum hemorrhage (PPH) due to overdistension of the myometrium. This double-blind randomized controlled trial compared the clinical efficacy and safety of a combined uterotonic regimen (intravenous oxytocin plus intramuscular ergometrine) against standard intravenous oxytocin alone for PPH prophylaxis following twin vaginal deliveries. Two hundred pregnant women with twin gestations at term attempting vaginal delivery were randomized into two equal groups (n = 100 per group). Immediately following the delivery of the second twin, the combined group received 5 IU intravenous oxytocin bolus plus 0.5 mg intramuscular ergometrine, while the single-agent group received 5 IU intravenous oxytocin plus an intramuscular saline placebo. The primary endpoint evaluated was the incidence of blood loss ≥ 500 mL. The incidence of PPH was significantly lower in the combined uterotonic group compared to the oxytocin-only group (8.0% vs. 19.0%; Relative Risk [RR] = 0.42; 95% CI, 0.20 to 0.89; p = 0.021). The mean total blood loss was also significantly reduced in the combined cohort (425.4 ± 115.8 mL vs. 580.6 ± 165.4 mL, p < 0.001). However, maternal adverse events, including transient hypertension (12.0% vs. 2.0%, p = 0.006) and postpartum nausea/vomiting (15.0% vs. 4.0%, p = 0.008), were more frequent in the combined arm. Prophylactic administration of oxytocin combined with ergometrine provides significantly superior protection against postpartum hemorrhage during twin vaginal deliveries, though careful maternal blood pressure screening is essential.

Keywords: Twin Vaginal Delivery; Postpartum Hemorrhage; Oxytocin; Ergometrine; Uterine Atony; Maternal Hemodynamics.

Manuscript Timeline: Received: May 20, 2026; Revised: July 08, 2026; Accepted: July 26, 2026; Published: August 11, 2026.

Citation: Obi EJ, Adeyemi FR, Dogara ZH. Prophylactic Use of Oxytocin Combined with Ergometrine versus Oxytocin Alone for Postpartum Hemorrhage Prevention during Twin Vaginal Deliveries. International Journal of Obstetrics and Gynecology. 2026; 14(8): 447–458.

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