A woman delivers vaginally and develops PPH due to uterine atony. Oxytocin, ergometrine, and misoprostol have been given. Uterine massage is ongoing. The NEXT pharmacological agent to be used according to current WHO guidelines is:
- A Tranexamic acid 1 g IV
- B Dinoprostone vaginal pessary
- C Carboprost (15-methyl PGF2α) 0.25 mg IM ✓
- D Vasopressin intrauterine injection
Correct answer: C. Carboprost (15-methyl PGF2α) 0.25 mg IM
Explanation
When oxytocin, ergometrine, and misoprostol fail to control atonic PPH, carboprost (15-methyl PGF2α) 0.25 mg IM every 15 minutes (maximum 8 doses) is the recommended next-line uterotonic. It is highly effective for refractory atony. Tranexamic acid addresses fibrinolysis and should be used alongside uterotonics but does not treat atony per se. Dinoprostone is used for cervical ripening rather than PPH. Intrauterine vasopressin is not a standard guideline recommendation.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.