Uterine atony-related postpartum hemorrhage (PPH) not responding to oxytocin and misoprostol is being managed. The correct sequence of second-line uterotonic agents according to current WHO/FIGO guidelines is:
- A Tranexamic acid first, then Ergometrine, then Carboprost
- B Carboprost first as it is most potent, then Ergometrine
- C Ergometrine → Carboprost → Tranexamic acid ✓
- D Oxytocin infusion escalation before any other agent
Correct answer: C. Ergometrine → Carboprost → Tranexamic acid
Explanation
WHO 2023 guidelines recommend oxytocin as first-line uterotonic. For oxytocin-resistant atony, ergometrine (or combined ergometrine-oxytocin) is the next step, followed by carboprost (15-methyl PGF2α, Hemabate) IM every 15-90 minutes, maximum 8 doses. Carboprost is contraindicated in asthma. Tranexamic acid (TXA) should be given within 3 hours of PPH onset as an antifibrinolytic adjunct (WOMAN trial showed mortality reduction) but does not treat atony. The WOMAN trial (2017) demonstrated TXA significantly reduced death from bleeding when given within 3 hours.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.