• Rebecca A Fanning, Florike Sheehan, Claire Leyden, Niamh Duffy, Luis F Iglesias-Martinez, Michael F Carey, Deirdre P Campion, and John J O'Connor.
• From the *Department of Perioperative Medicine, Coombe Women and Infants University Hospital, Dublin, Ireland; †UCD School of Biomolecular and Biomedical Science, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland; ‡Systems Biology Ireland, University College Dublin, Dublin, Ireland; and §UCD School of Veterinary Medicine, University College Dublin, Dublin, Ireland.
• Anesth. Analg. 2017 May 1; 124 (5): 1581-1588.

BackgroundErgometrine is a uterotonic agent that is recommended in the prevention and management of postpartum hemorrhage. Despite its long-standing use, the mechanism by which it acts in humans has never been elucidated fully. The objective of this study was to investigate the role of adrenoreceptors in ergometrine's mechanism of action in human myometrium. The study examined the hypothesis that α-adrenoreceptor antagonism would result in the reversal of the uterotonic effects of ergometrine.MethodsMyometrial samples were obtained from women undergoing elective cesarean delivery. The samples were then dissected into strips and mounted in organ bath chambers. After the generation of an ergometrine concentration-response curve (10 to 10 M), strips were treated with increasing concentrations of ergometrine (10 to 10 M) alone and ergometrine (10 to 10 M) in the presence of phentolamine (10 M), prazosin (10 M), propranolol (10 M), or yohimbine (10 M). The effects of adding ergometrine and the effect of drug combinations were analyzed using linear mixed effects models with measures of amplitude (g), frequency (contractions/10 min), and motility index (g×contractions/10 min).ResultsA total of 157 experiments were completed on samples obtained from 33 women. There was a significant increase in the motility index (adding 0.342 g × counts/10 min/μM; 95% confidence interval [CI], 0.253-0.431, P < .001), amplitude (0.078 g/μM; 95% CI, 0.0344-0.121, P = 5e-04), and frequency (0.051 counts/10 min/μM; 95% CI, 0.038-0.063, P < .001) in the presence of ergometrine. The α-adrenergic antagonist phentolamine and the more selective α1-adrenergic antagonist prazosin inhibited the ergometrine mediated increase in motility index, amplitude, and frequency (-1.63 g × counts/10 min/μM and -16.70 g × counts/10 min/μM for motility index, respectively).ConclusionsThese results provide novel evidence for a role for α-adrenergic signaling mechanisms in the action of ergometrine on human myometrial smooth muscle in the in vitro setting. Information that sheds light on the mechanism of action of ergometrine may have implications for the development of further uterotonic agents.

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