A Cochrane review included 8 studies with a total of 4009 subjects. The use of injected ergot alkaloids in the third stage of labour significantly decreased mean blood loss (weighted mean difference -80.52 ml, 95% confidence interval (CI) -96.39 to -64.656.66 ml; 3 trials, n=2718) and postpartum haemorrhage of at least 500 ml (relative risk (RR) 0.52, 95% CI 0.28 to 0.94; 5 trials, n=3708, I²=83), and increased maternal haemoglobin concentration (g/dL) at 24 to 48 hours postpartum (MD 0.50 g/dL, 95% CI 0.38 to 0.62; 1 trial, n=1429). The risk of retained placenta or manual removal of the placenta, or both, were inconsistent. Ergot alkaloids increased the risk of vomiting (RR 11.81, 95% CI 1.78 to 78.28), elevation of blood pressure (RR 2.60, 95% CI 1.03 to 6.57) and pain after birth requiring analgesia (RR 2.53, 95% CI 1.34 to 4.78). One study compared oral ergometrine with placebo and showed no significant benefit of ergometrine over placebo. There were no included trials that compared different administration regimens of ergot alkaloids.
Comment: The quality of evidence is downgraded by study limitations.