In Reply:

In Reply: We thank Drs. Boucherie, Rousseau, and Quibel for their interest in our study in the December 2024 issue comparing the efficacy of methylergonovine and carboprost tromethamine for the treatment of uterine atony in cesarean delivery.1 The authors question the use of a uterine tone score as the primary outcome in our study. This validated numeric rating scale was chosen because it represents the most direct measure of the desired clinical effect of these uterotonic drugs; namely, firm contraction of the uterus. A previous trial evaluating the 0–10 uterine tone score in cesarean deliveries demonstrated good-to-excellent interrater reliability across health care professionals of varying experience levels.2 A more recent trial demonstrated a strong correlation between the obstetricians' estimate of uterine tone using this scoring system and subsequent severe hemorrhage and blood transfusion (Koons NJ, Stanwyck C, Xie J, Michel G, Lyell D, Carvalho B, et al. Uterine tone numeric rating score as an early indicator of major postpartum hemorrhage during cesarean delivery: a prospective observational study. Anesthesiology. In press). We agree that blood loss and transfusion requirements are clinically meaningful individual outcomes in uterine atony. Blood loss, transfusion requirements, and need for additional uterotonics were therefore among the reported secondary outcomes. However, powering the study to detect a meaningful difference in these outcomes would not have been feasible for this initial trial.