A patient delivers vaginally and has an estimated blood loss of 800 mL. Uterine massage is performed and 10 units of syntocinon are given IM, but the uterus remains atonic. The next drug of choice to administer is:
- A Ergometrine 0.5 mg IM
- B Misoprostol 800 mcg sublingual
- C Carboprost (15-methyl PGF2α) 250 mcg IM ✓
- D Tranexamic acid 1 g IV
Correct answer: C. Carboprost (15-methyl PGF2α) 250 mcg IM
Explanation
After failure of first-line oxytocin, carboprost (15-methyl PGF2α) 250 mcg IM is the next agent of choice for uterine atony. It is a potent uterotonic with a maximum total dose of 2 mg and is contraindicated in asthma. Ergometrine is an alternative but carboprost is more potent. Misoprostol can be used if injectables are unavailable. Tranexamic acid targets fibrinolysis and is used adjunctively but does not treat atony.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.