A 26-year-old primigravida develops an atonic uterus immediately after vaginal delivery with blood loss of 800 mL. Her blood pressure is 168/112 mmHg with 3+ proteinuria and she has facial edema. Which uterotonic agent should be avoided?

• A Oxytocin 10 IU intramuscular
• B Misoprostol 600 mcg sublingual
• C Carboprost 250 mcg intramuscular
• D Ergometrine 0.5 mg intramuscular ✓

Explanation

Ergot alkaloids cause sustained smooth muscle contraction of both uterus and systemic vasculature, producing vasoconstriction and a sharp rise in blood pressure. They are contraindicated in preeclampsia, eclampsia, and chronic hypertension because they can precipitate hypertensive crises and seizures. Oxytocin, misoprostol, and carboprost do not carry this pressor effect, so all three remain usable in this patient.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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