Which uterotonics combination is recommended as SECOND-LINE treatment for uterine atony unresponsive to oxytocin, according to WHO PPH guidelines?
- A Carboprost (15-methyl PGF2α) intramuscularly ✓
- B Ergometrine alone
- C Misoprostol 600 µg sublingual
- D Tranexamic acid intravenously
Correct answer: A. Carboprost (15-methyl PGF2α) intramuscularly
Explanation
When uterine atony persists despite adequate oxytocin, carboprost (15-methyl PGF2α, Hemabate) 250 µg IM repeated every 15 minutes (maximum 8 doses) is the preferred second-line uterotonic for refractory atony. It is contraindicated in asthma. Ergometrine may be used concurrently but is not the primary second-line agent on its own. Tranexamic acid (TXA) is an antifibrinolytic given alongside uterotonics but does not replace them.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.