A nulliparous woman at 41+2 weeks is being induced with a Bishop score of 3. Cervical ripening is initiated with dinoprostone 0.5 mg intracervical gel. Six hours later, Bishop score is 5 but FHR shows uterine hyperstimulation with late decelerations. What is the immediate management?
- A Proceed to emergency cesarean delivery immediately
- B Increase the dinoprostone dose to 1 mg and expedite cervical ripening
- C Administer tocolysis with subcutaneous terbutaline 0.25 mg and reassess CTG ✓
- D Manually perform cervical sweeping to stimulate endogenous prostaglandins
Correct answer: C. Administer tocolysis with subcutaneous terbutaline 0.25 mg and reassess CTG
Explanation
Uterine hyperstimulation (tachysystole with FHR abnormalities) from prostaglandins is managed by stopping any prostaglandin administration, maternal repositioning to lateral decubitus, oxygen supplementation, IV fluid bolus, and if necessary tocolysis with terbutaline 0.25 mg SC to rapidly relax the uterus. Immediate cesarean is warranted only if the FHR abnormality does not resolve with these measures. Increasing the dose would worsen hyperstimulation.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.