A 26-year-old primipara delivers a 3.8 kg baby. After active management of the third stage, 900 mL blood loss occurs with a soft uterus. Two doses of oxytocin IM and one dose of ergometrine have been given. The NEXT step in the medical management of this atonic PPH should be:

• A Tranexamic acid 1 g IV ✓
• B Intramyometrial carboprost 0.25 mg
• C Sublingual misoprostol 800 mcg
• D IV dinoprostone infusion

Explanation

After failed first-line uterotonics (oxytocin + ergometrine), the WHO World Maternal Antifibrinolytic Trial (WOMAN trial 2017) demonstrated that tranexamic acid 1 g IV given within 3 hours of delivery significantly reduces death from PPH bleeding without increasing thromboembolic events. Carboprost is a valid second-line uterotonic but tranexamic acid is recommended concurrently as an antifibrinolytic adjunct once significant bleeding is established. Dinoprostone is not a standard PPH uterotonic.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.