A 35-year-old G5P4 with a history of three vaginal deliveries and one cesarean section delivers vaginally at 38 weeks. After delivery of the placenta, she bleeds heavily. The uterus is boggy and fails to contract despite oxytocin and uterine massage. Her hemoglobin drops from 11 g/dL to 7 g/dL over 2 hours. She is a known case of bronchial asthma. Which second-line uterotonic is the safest choice in this patient?

• A Carboprost (15-methyl PGF2α) IM
• B Methylergometrine IM
• C Oxytocin 20 IU in 500 mL Ringer lactate rapid infusion
• D Misoprostol 800 mcg rectally ✓

Explanation

Carboprost is contraindicated in asthma because PGF2α causes bronchospasm. Methylergometrine is contraindicated in hypertension and preeclampsia but is not specifically contraindicated in asthma. Misoprostol (PGE1 analog) does not cause bronchospasm and is safe in asthma. However, the safest and most effective choice here is misoprostol rectally. Oxytocin infusion is first-line and has already failed.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.