From the FDA Drug Label
In some selected cases, however, multiple closing at intervals of 15 to 90 minutes was carried out with successful outcome. The FDA drug label does not answer the question about syntometrine.
From the Research
Syntometrine can be given again after 2-5 minutes if uterine atony persists following the initial dose, as recommended by recent guidelines and studies 1, 2, 3. The standard approach is to administer a second dose of Syntometrine (containing 5 units of oxytocin and 0.5 mg of ergometrine) if the uterus remains atonic after the first dose. However, it's essential to note that a maximum of two doses of Syntometrine should be given, as additional doses increase the risk of side effects such as hypertension, nausea, and vomiting due to the ergometrine component. Some key points to consider when administering Syntometrine include:
- The optimal prophylactic dose of oxytocin differs depending on the patient population, but less than 5 units and as low as a fraction of one unit is needed for PPH prevention, with an increased requirement within that range for cesarean birth, those on magnesium, and advanced maternal age 1.
- Carbetocin is an appropriate alternative to oxytocin, and misoprostol shows limited to no efficacy for uterine atony in recent studies 1.
- If bleeding continues after the second dose of Syntometrine, alternative uterotonic agents should be considered as part of the postpartum hemorrhage management protocol, such as additional oxytocin, misoprostol, carboprost (Hemabate), or tranexamic acid 2. The timing between doses allows for assessment of the uterine response while balancing the need for prompt intervention in cases of ongoing hemorrhage. When administering repeated doses, careful monitoring of blood pressure is essential due to the vasoconstrictive effects of ergometrine. Recent studies suggest that oxytocin bolus 0.5-3 UI is considered an effective prophylactic dose, and the recommended effective prophylactic oxytocin infusion dose is 7.72 IU/h 3. However, the most recent and highest-quality study 3 should be prioritized when making decisions about Syntometrine administration.