Name of the Procedure:

Injection, methylergonovine maleate, up to 0.2 mg (HCPCS Code J2210)

Common names:

• Methergine injection
• Methylergonovine injection

Technical or medical terms:

• Methylergonovine maleate administration

Summary

The methylergonovine maleate injection is a medical procedure where a specific dose (up to 0.2 mg) of methylergonovine maleate is administered via injection. This medication is used primarily to control bleeding after childbirth.

Purpose

Medical conditions addressed:

• Postpartum hemorrhage

Goals/expected outcomes:

• To reduce uterine bleeding after childbirth
• To help the uterus contract and prevent excessive blood loss

Indications

Symptoms or conditions warranting the procedure:

• Heavy bleeding after delivery (postpartum hemorrhage)

Patient criteria:

• Women who have just given birth and are experiencing abnormal uterine bleeding

Preparation

Pre-procedure instructions:

• Follow the physician's guidance regarding any dietary restrictions or medication adjustments.

Diagnostic tests or assessments:

• Physical examination
• Check for contraindications such as hypertension

Procedure Description

1. Assessment: The healthcare provider evaluates the patient's condition.
2. Preparation: The injection site is cleaned with an antiseptic solution.
3. Injection: Methylergonovine maleate is injected, usually intramuscularly but can be given intravenously in an emergency.
4. Monitoring: The patient is monitored for adverse reactions and to ensure effectiveness.

Tools and equipment used:

• Syringe and needle
• Antiseptic solution

Anesthesia or sedation:

• Not typically required

Duration

The injection itself takes only a few minutes, but monitoring may extend the overall time to approximately 30 minutes.

Setting

Where performed:

• Hospital
• Delivery room
• Outpatient clinic

Personnel

Healthcare professionals involved:

• Obstetrician
• Registered nurse
• Midwife

Risks and Complications

Common risks:

• Mild pain or discomfort at the injection site
• Nausea
• Headache

Rare risks:

• Hypertension
• Chest pain
• Severe allergic reactions

Management of complications:

• Immediate medical intervention for any severe adverse reactions
• Close monitoring of vital signs

Benefits

Expected benefits:

• Quick control of postpartum bleeding
• Prevention of severe blood loss and related complications

Onset of benefits:

• Typically noticed within minutes after administration

Recovery

Post-procedure care:

• Close monitoring for any adverse effects
• Instructions on signs of complications to watch for

Expected recovery time:

• Immediate stabilization with ongoing observation for a few hours

Restrictions or follow-up:

• Follow-up appointments to check overall recovery and uterine contraction

Alternatives

Other treatment options:

• Oral methylergonovine maleate
• Oxytocin administration
• Manual uterine massage

Pros and cons:

• Injectable methylergonovine is fast-acting compared to oral medication.
• Oxytocin is another effective drug but may not work as quickly.
• Manual massage requires no medication but is labor-intensive and less efficient.

Patient Experience

During the procedure:

• The patient will feel a brief sting or mild discomfort at the injection site.

After the procedure:

• Some side effects like mild nausea or headache may occur.
• Vital signs and bleeding will be closely monitored to ensure the procedure's effectiveness.

Pain management and comfort measures:

• Reassurance and support from healthcare providers
• Pain relief as required