A 38-year-old primigravida at 41+3 weeks has a Bishop score of 3. She is to be induced. Dinoprostone (PGE2) gel is applied intracervically. She is being monitored. After 6 hours, she develops uterine tachysystole (>5 contractions in 10 minutes) and fetal heart rate decelerations. What is the first-line tocolytic to reverse dinoprostone-induced uterine hyperstimulation?
- A Atosiban (oxytocin antagonist)
- B Salbutamol 5 mg orally
- C Terbutaline 0.25 mg subcutaneously ✓
- D Nifedipine 10 mg sublingual
Explanation
Uterine hyperstimulation or tachysystole induced by prostaglandins (PGE2 or misoprostol) with fetal heart rate changes requires prompt intervention. The first-line acute tocolytic for prostaglandin-induced tachysystole is terbutaline 0.25 mg subcutaneously (or IV), a beta-2 adrenergic agonist that rapidly causes uterine relaxation. It acts within minutes. The cervical dinoprostone gel/insert should also be removed if possible. Atosiban is appropriate for preventing preterm labor but is slower acting and not standard in this acute scenario. Nifedipine acts in 15–30 minutes and is used for preterm labor. Per NICE and RCOG guidelines, terbutaline SC is the recommended acute tocolytic for induction-related hyperstimulation.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.