A woman delivers vaginally after oxytocin augmentation. Thirty minutes post-delivery, the uterus is boggy, there is active vaginal bleeding 800 mL, BP 90/60 mmHg, and the placenta has been delivered intact. After bimanual compression and IV oxytocin 20 units infusion, bleeding continues. Which is the NEXT most appropriate uterotonic?

• A Misoprostol 800 mcg sublingual
• B Methylergometrine 0.2 mg IV
• C Carboprost (15-methyl PGF2α) 250 mcg IM ✓
• D Tranexamic acid 1g IV

Explanation

Carboprost (15-methyl PGF2α) 250 mcg IM is a potent second-line uterotonic indicated when oxytocin fails to control atonic PPH; it can be repeated every 15–90 minutes up to 8 doses. Methylergometrine is contraindicated with hypertension (BP 90/60 with active hemorrhage may rebound with hypertension risk and it is generally avoided in eclamptic/hypertensive patients). Tranexamic acid is an antifibrinolytic adjunct, not a uterotonic. Misoprostol is less potent than carboprost as second-line therapy.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.