History · Last reviewed 2026-10-18

Ergometrine: the ergot alkaloid that stops bleeding after childbirth

Ergometrine, also called ergonovine or ergobasine, is the water-soluble ergot alkaloid that makes the uterus contract; it was identified almost simultaneously by four laboratories in 1935, among them Harold Dudley and Chassar Moir in London. It is still on the World Health Organization Model List of Essential Medicines as a uterotonic for postpartum haemorrhage, although oxytocin is the agent WHO recommends first for prevention. [1, 2, 3, 4]

Key takeaways

  • Midwives used ergot to speed childbirth from at least 1582; by the 1820s that use was abandoned as dangerous and ergot was kept for bleeding after birth.
  • Ergometrine was isolated in 1935 by four groups, which is why it has several names: ergometrine and ergobasine in Europe, ergonovine in the United States.
  • It is a simple amide of lysergic acid, the same scaffold as LSA and LSD.
  • A 2018 Cochrane review found that injected ergot alkaloids reduce blood loss and postpartum haemorrhage but raise blood pressure.
  • Methylergometrine, a semi-synthetic relative introduced in 1946, is used the same way.

From folk remedy to dangerous drug

Ergot, the sclerotium of Claviceps purpurea, was first described in print as a remedy used by midwives to quicken childbirth by Adam Lonicer in 1582. [5, 1] The same alkaloids caused ergotism, and the dose of crude ergot was impossible to control: van Dongen and de Groot note that frequent ruptures of the uterus turned its nickname from pulvis ad partum, powder for birth, into pulvis ad mortem. [6]

In the United States John Stearns described ergot for quickening labour in 1808, and an inquiry by the Medical Society of New York into rising stillbirths recommended in 1824 that it be used only to control haemorrhage after birth. [1] From the late 1820s ergot was used in obstetrics to prevent postpartum haemorrhage rather than to speed delivery. [6]

The search for the active principle

Around 1900 ergot was, in the phrase Lee quotes, a "glorious chemical mess". [7] At the Wellcome laboratories Henry Dale, George Barger and colleagues isolated ergotoxine, which later proved to be a mixture of three alkaloids and a false lead for obstetrics; in Basel, Arthur Stoll isolated ergotamine in 1918. [8] Neither was the water-soluble substance behind ergot's traditional effect on the uterus. [8, 9]

The obstetrician Chassar Moir led the research in the early 1930s that identified the active water-soluble component. [9] In March 1935 he and the chemist Harold Dudley published "The substance responsible for the traditional clinical effect of ergot" in the British Medical Journal. [2]

Four laboratories, four names

In 1935 the same alkaloid was found almost simultaneously in four separate laboratories, and each gave it a name: ergometrine, ergotocine, ergosterine and ergobasine. Ergometrine and ergobasine stuck in Europe, ergonovine in the United States. [1, 5]

Its structure was worked out the same year: hydrolysis split it into (+)-lysergic acid and (+)-2-aminopropanol, so it is a simple amide of lysergic acid. It entered commerce in 1936, and in 1938 it was made by joining those two parts, the first synthesis of an ergot alkaloid. [1] That synthesis, at Sandoz, belongs to the work that led Albert Hofmann to LSD the same year. [10]

Ergometrine among its lysergic acid amide relatives
CompoundAmine joined to lysergic acidOrigin
Ergine (LSA)Ammonia (simple amide)Natural: ergot fungi and morning glory seeds
Ergometrine (ergonovine)2-aminopropanolNatural: ergot; also made from lysergic acid
Methylergometrine2-aminobutanolSemi-synthetic, introduced 1946
LSDDiethylamineSemi-synthetic, 1938

Sources for the table: Schiff (2006) for ergometrine and methylergometrine, Hofmann and Tscherter (1960) for ergine in morning glory seeds. [1, 11]

How it works and how it is used

Ergometrine's most marked effect is direct stimulation of the uterine muscle, raising its tone and the force and rate of its contractions, an action most closely linked to agonism at 5-HT2 serotonin receptors. [1] It is given after the placenta has been delivered, because earlier use can trap the placenta, and it is contraindicated for inducing labour. [1] Ergot derivatives are broken down by the liver enzyme CYP3A4, so strong inhibitors of that enzyme can provoke acute ergot toxicity. [1] For the receptor pharmacology of the wider family, see ergot alkaloid pharmacology.

The trial evidence is summarised in a 2018 Cochrane review of eight studies with about 4,000 women: prophylactic ergot alkaloids, mostly by injection, reduced mean blood loss and the risk of postpartum haemorrhage of at least 500 mL (risk ratio 0.52), but increased the risk of raised blood pressure (risk ratio 2.60) and of pain after birth. Evidence on severe haemorrhage and on tablets was lacking. [12]

Postpartum haemorrhage is the leading cause of maternal death worldwide, and WHO's current recommendation for preventing it is oxytocin. [4] Writing in 1995, van Dongen and de Groot already concluded that ergometrine's side effects and instability made it not the drug of choice. [6] It nonetheless remains on WHO's Model List of Essential Medicines, in the uterotonics section, for postpartum haemorrhage. [3]

Methylergometrine

Methylergometrine (methylergonovine) does not occur in ergot. It was introduced as a semi-synthetic medicine in 1946, made from lysergic acid and an aminobutanol, and is approved in the United States for postpartum uterine atony and haemorrhage after delivery of the placenta. [1] Accidental exposure of children is dangerous: a Belgian series of 34 cases from 1969 to 1999 included newborns with apnoea, coma and convulsions. [13]

Questions and answers

Who discovered ergometrine?

Ergometrine was identified almost simultaneously by four laboratories in 1935; Harold Dudley and Chassar Moir published it in the British Medical Journal in March 1935, and the other groups named it ergotocine, ergosterine and ergobasine. [2, 1]

Is ergometrine the same as ergonovine?

Yes. Ergometrine, ergonovine and ergobasine are names for the same alkaloid; ergometrine and ergobasine are used in Europe and ergonovine in the United States. [1]

Is ergometrine still used for postpartum haemorrhage?

Yes. Ergometrine is on the WHO Model List of Essential Medicines as a uterotonic for postpartum haemorrhage, though WHO recommends oxytocin first for prevention, and ergot alkaloids raise blood pressure. [3, 4, 12]

References

  1. Schiff PL (2006). Ergot and its alkaloids. American Journal of Pharmaceutical Education 70(5):98. doi:10.5688/aj700598 PubMed 17149427
  2. Dudley HW, Moir C (1935). The substance responsible for the traditional clinical effect of ergot. British Medical Journal 1(3871):520-523. doi:10.1136/bmj.1.3871.520 PubMed 20778930
  3. World Health Organization. WHO Model List of Essential Medicines (eEML), entry for ergometrine: section Uterotonics, indication postpartum haemorrhage. Checked 18 October 2026. Official text
  4. Gallos ID, Yunas I, Devall AJ, et al. (2025). Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. Cochrane Database of Systematic Reviews 4:CD011689. doi:10.1002/14651858.CD011689.pub4 PubMed 40237648
  5. Hofmann A (1978). Historical view on ergot alkaloids. Pharmacology 16 Suppl 1:1-11. doi:10.1159/000136803 PubMed 347462
  6. van Dongen PW, de Groot AN (1995). History of ergot alkaloids from ergotism to ergometrine. European Journal of Obstetrics, Gynecology and Reproductive Biology 60(2):109-116. doi:10.1016/0028-2243(95)02104-z PubMed 7641960
  7. Lee MR (2009). The history of ergot of rye (Claviceps purpurea) I: from antiquity to 1900. Journal of the Royal College of Physicians of Edinburgh 39(2):179-184. PubMed 19847980
  8. Lee MR (2009). The history of ergot of rye (Claviceps purpurea) II: 1900-1940. Journal of the Royal College of Physicians of Edinburgh 39(4):365-369. doi:10.4997/jrcpe.2009.416 PubMed 20509463
  9. Dunn PM (2002). John Chassar Moir (1900-1977) and the discovery of ergometrine. Archives of Disease in Childhood: Fetal and Neonatal Edition 87(2):F152-F154. doi:10.1136/fn.87.2.f152 PubMed 12193527
  10. Hofmann A (1980). LSD: My Problem Child. McGraw-Hill, New York. (Originally LSD: Mein Sorgenkind, Klett-Cotta, 1979.)
  11. Hofmann A, Tscherter H (1960). Isolierung von Lysergsäure-Alkaloiden aus der mexikanischen Zauberdroge Ololiuqui (Rivea corymbosa (L.) Hall. f.). Experientia 16:414. doi:10.1007/BF02178840 PubMed 13715089
  12. Liabsuetrakul T, Choobun T, Peeyananjarassri K, Islam QM (2018). Prophylactic use of ergot alkaloids in the third stage of labour. Cochrane Database of Systematic Reviews 6:CD005456. doi:10.1002/14651858.CD005456.pub3 PubMed 29879293
  13. Aeby A, Johansson AB, De Schuiteneer B, Blum D (2003). Methylergometrine poisoning in children: review of 34 cases. Journal of Toxicology: Clinical Toxicology 41(3):249-253. doi:10.1081/clt-120021107 PubMed 12807307

Read next