A primigravida delivers a 4.5 kg baby after a prolonged second stage. One hour postpartum she has lost 800 mL blood. The uterus is boggy at the umbilicus. Oxytocin 10 IU has been given. Uterine massage has been performed. The next step is:
- A Ergometrine 0.2 mg IV ✓
- B Oxytocin infusion at 40 IU in 500 mL over 4 hours
- C Misoprostol 800 mcg rectally
- D B-Lynch suture
Correct answer: A. Ergometrine 0.2 mg IV
Explanation
For atonic PPH unresponsive to oxytocin and massage, ergometrine (methylergometrine) 0.2 mg IV is the standard second-line uterotonic. It acts on alpha-adrenergic and serotonin receptors causing sustained uterine contraction. Misoprostol is an alternative but ergometrine is preferred in this setting per RCOG.
Reference: RCOG Green-top Guideline No. 52, 2016 (revised 2017) ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.