A 28-year-old G5P4 at 38 weeks delivers vaginally and has PPH due to uterine atony. She has received oxytocin infusion and one dose of carboprost (250 mcg IM). Bleeding continues. The next step in pharmacological management according to most guidelines is:
- A Misoprostol 800 mcg per rectum ✓
- B Repeat carboprost 250 mcg IM
- C Methylergometrine 0.2 mg IM
- D Oxytocin 10 IU IV bolus
Correct answer: A. Misoprostol 800 mcg per rectum
Explanation
After oxytocin and carboprost (PGF2α) have failed, misoprostol (PGE1) 800 mcg per rectum is recommended as a second-line uterotonic. Methylergometrine and carboprost are both first-line agents given earlier; repeating carboprost without effect adds risk (maximum 8 doses). Misoprostol via rectal route provides sustained absorption.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.