After a normal vaginal delivery, a primipara develops PPH. Uterine massage, IV oxytocin 20 units, and IM carboprost have been given. Bleeding continues. Bimanual compression is being maintained. The NEXT pharmacological agent of choice per WHO 2023 PPH guidelines is:

• A IV tranexamic acid 1 g ✓
• B IV ergometrine 0.5 mg
• C Sublingual misoprostol 800 mcg
• D Rectal dinoprostone 20 mg

Explanation

WHO 2023 PPH guidelines recommend IV tranexamic acid 1 g (given within 3 hours of birth, repeated once if bleeding continues after 30 minutes) as early adjunct treatment for PPH regardless of cause, in addition to uterotonics. It reduces PPH mortality significantly (WOMAN trial). Ergometrine is a uterotonic already superseded by carboprost; misoprostol is a second-line uterotonic. Tranexamic acid (antifibrinolytic) addresses the coagulopathic component.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.