A woman delivers vaginally and immediately afterwards develops PPH with a boggy uterus. She has received 10 IU oxytocin IV bolus and 0.2 mg ergometrine. Uterus is now atonic despite bimanual compression for 5 minutes. The NEXT drug of choice per WHO 2023 guidelines is:
- A Tranexamic acid 1 g IV within 3 hours ✓
- B Carboprost (15-methyl PGF2α) 0.25 mg IM
- C Sublingual misoprostol 800 mcg
- D IV oxytocin infusion 40 IU in 500 mL saline
Correct answer: A. Tranexamic acid 1 g IV within 3 hours
Explanation
WHO 2023 and FOGSI guidelines strongly recommend tranexamic acid (TXA) 1 g IV as early as possible (within 3 hours of PPH onset) as adjuvant treatment for all PPH cases, based on the WOMAN trial showing reduced PPH mortality without thrombotic risk. It should be given concurrently with ongoing uterotonic therapy. While carboprost and misoprostol are uterotonic options, TXA targets hyperfibrinolysis which is a parallel mechanism in PPH and is the most updated recommendation.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.