Methylergometrine-induced acute coronary vasospasm in a postpartum patient following caesarean delivery of DCDA twins

A woman in her early 30s with a twin pregnancy conceived through ovulation induction underwent elective caesarean delivery at term. Soon after administration of intramuscular methylergometrine (0.2 mg) for mild postpartum bleeding, she developed sudden, severe chest pain with breathlessness. Her ECG showed diffuse ST-segment depression with reciprocal elevation in aVR, and cardiac enzymes were raised. Echocardiography revealed mild left ventricular hypokinesia, while coronary angiography demonstrated normal arteries. She responded promptly to nitrate therapy and supportive care. The temporal relationship between methylergometrine administration and symptom onset, together with angiographically normal coronaries, confirmed coronary vasospasm secondary to methylergometrine. This case underscores the need for careful cardiovascular monitoring when vasoconstrictive uterotonics are used in the postpartum period, particularly in women with predisposing factors such as multiple gestation.