A patient develops PPH unresponsive to oxytocin and methylergometrine. Carboprost (15-methyl PGF2α) is contraindicated. The second-line uterotonic of choice in a patient with asthma is:

• A Carbetocin 100 mcg IV
• B Sulprostone IV infusion
• C Misoprostol 800 mcg sublingual ✓
• D Dinoprostone vaginal suppository

Explanation

Carboprost (15-methyl PGF2α) is contraindicated in asthma because it causes bronchoconstriction via PGF2α-mediated smooth muscle contraction. Misoprostol (PGE1 analogue) is the preferred alternative as it causes bronchodilation rather than bronchoconstriction and is safe in asthma. Carbetocin is a long-acting oxytocin analogue used primarily in elective cesarean sections. Sulprostone (PGE2 analogue) is also contraindicated in cardiovascular disease and asthma. Misoprostol 800–1000 mcg rectally or sublingually is the WHO-recommended uterotonic when parenteral agents are unavailable or contraindicated.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.