A woman delivers a 3.8 kg baby vaginally and the placenta is delivered 5 minutes later. She develops bright red vaginal bleeding estimated at 700 mL. The uterus is soft and boggy on examination. Initial bimanual uterine massage is performed. Which is the FIRST-LINE uterotonic drug to be administered?
- A Oxytocin 10 IU intramuscular or IV bolus ✓
- B Misoprostol 600 mcg sublingual
- C Carboprost 250 mcg intramuscular
- D Ergometrine 0.5 mg intramuscular
Correct answer: A. Oxytocin 10 IU intramuscular or IV bolus
Explanation
Uterine atony is the most common cause of postpartum hemorrhage (PPH), accounting for approximately 80% of cases. Oxytocin is the first-line uterotonic for management of PPH due to uterine atony. It is given as 10 IU IM or a slow IV infusion. Carboprost (prostaglandin F2α) is a second-line agent contraindicated in asthma, and misoprostol is used when oxytocin is unavailable.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.