A woman develops atonic PPH after vaginal delivery. She has received oxytocin infusion and carboprost 250 mcg IM twice, 15 minutes apart, but bleeding continues. According to standard PPH protocols, what is the next recommended uterotonic agent?
- A Misoprostol 800 mcg sublingual ✓
- B Repeat carboprost 250 mcg IM
- C Methylergometrine 0.2 mg IM
- D Oxytocin 20 IU IV bolus
Correct answer: A. Misoprostol 800 mcg sublingual
Explanation
When oxytocin and carboprost fail, misoprostol 800 mcg sublingual or per rectum is the recommended third-line uterotonic. Carboprost has a maximum dose of 2 mg and repeating it without interval is not advised. Methylergometrine is usually given earlier. Oxytocin bolus is first-line.
Reference: Dutta's Textbook of Obstetrics, 9th ed.
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