Excessive bleeding after dilation and evacuation (D&E) requiring interventions is common, occurring in approximately 30% of cases at one large abortion-providing clinic. Uterotonic prophylaxis at the time of D&E, particularly with methylergonovine maleate (MM), is a common practice among D&E providers despite nearly no evidence for its efficacy. Finding ways to decrease excessive bleeding after D&E has the potential both to improve patient safety and to reduce costs of provider-initiated interventions. The investigators propose a randomized, controlled trial to investigate the efficacy of MM prophylaxis versus placebo in decreasing excessive bleeding measured by a composite outcome among women undergoing D&E at 20 to 24 weeks.

Inclusion Criteria:

• Between 20 wks 0 days gestation and 24 wks 0 days gestation
• English or Spanish speaking
• BP before injection 140/90 or below
• 18 years old or over

Exclusion criteria:

• hypertension either on the preoperative or operative day (defined as systolic blood pressure greater than 140 mmHg or diastolic blood pressure greater than 90 mmHg)
• D&E procedures with more than one day of cervical preparation with dilators
• use of protease inhibitors
• known coagulopathy
• known morbidly adherent placenta

2 years, March 2015 to March 2017

It took from March 2015 to March 2017 to meet the study sample size. Therefore, the timeframe March 2015 through March 2017 is the duration that adverse events were monitored/collected.

Designed our study using a one-sided hypothesis given our belief that methergine could not cause increased bleeding based on postpartum data.