A 29-year-old primigravida at 39 weeks with severe preeclampsia (BP 168/112 mmHg, proteinuria 3+) delivers vaginally and develops atonic postpartum hemorrhage with a soft uterus. Which uterotonic agent should be avoided in this patient?
- A Oxytocin infusion
- B Misoprostol
- C Methylergometrine ✓
- D Carboprost tromethamine
Correct answer: C. Methylergometrine
Explanation
Ergot alkaloids such as methylergometrine cause sustained smooth muscle contraction of vascular walls, producing marked hypertension. They are contraindicated in preeclampsia, eclampsia, chronic hypertension, and cardiac disease. Oxytocin, misoprostol, and carboprost are all acceptable here, although carboprost warrants caution in asthma, not hypertension, which is the distinguishing point tested.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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