Beware of administration of methylergometrine prior to uterine incision and delivery; venous air embolism during caesarean section

Caesarean section has been associated with venous air embolism. Uterine sinuses are vulnerable to the entrance of air, especially in the presence of placenta previa. We report a 32-year-old, gravida-IV admitted with antepartum haemorrhage and intra-uterine foetal demise at 34-weeks of gestation. She underwent an emergency caesarean section under general anaesthesia and developed venous air embolism intra-operatively which was managed successfully. We speculate, the administration of methylergometrine prior to uterine incision probably lead to 'iatrogenic' abruption of the placenta and venous air embolism. We recommend anaesthesiologists to avoid or be cautious while administering oxytocics prior to uterine incision (in case of intra-uterine foetal demise).