Objective To explore the clinical efficacy and safety,and the influence on coagulation function of the combined use of ergometrine maleate and oxytocin in preventing postpartum hemorrhage in high-risk pregnant women. Methods A total of 86 highrisk pregnant women admitted to the Yuzhou Maternal and Child Health Hospital from June 2024 to August 2025 were randomly divided into control group and observation group, 43 cases in each group, using a random number table method. The control group was treated with oxytocin alone, while the observation group was treated with oxytocin combined with methylergometrine maleate. The two groups were compared in terms of postpartum bleeding volume at 2 and 24 hours, uterine contraction recovery time, incidence of postpartum bleeding, coagulation function indicators, and adverse drug reactions. Results Compared with the control group, the observation group had significantly lower bleeding volume at 2 and 24 hours postpartum (all P＜0.05), and a significantly shorter recovery time for uterine contractions (P＜0.05). The incidence of postpartum hemorrhage in the observation group was significantly lower than that in the control group (P＜0.05). After treatment, prothrombin time (PT) and activated partial thromboplastin time (APTT) decreased and fibrinogen (FIB) increased in both groups (all P＜0.05), with the observation group showing significantly shorter PT and APTT and higher FIB than the control group (all P＜0.05). There was no statistical significant difference in the incidence of adverse reactions between the two groups of drugs (P＞0.05). Conclusion The combined application of ergometrine maleate and oxytocin significantly reduced the amount of bleeding at 2 and 24 hours postpartum, shortened the recovery time of uterine contractions, and reduced the incidence of postpartum bleeding, with good safety.