A 35-year-old woman has an uncomplicated vaginal delivery. At 1 hour postpartum the uterine fundus is above the umbilicus and soft, vaginal bleeding is 650 mL. Bimanual compression and IV oxytocin 20 units have been given. The NEXT pharmacological agent of choice per WHO guidelines is:
- A Sublingual misoprostol 800 µg
- B IM carboprost (15-methyl PGF2α) 250 µg ✓
- C IM carbetocin 100 µg
- D IV ergometrine 0.5 mg
Correct answer: B. IM carboprost (15-methyl PGF2α) 250 µg
Explanation
When oxytocin fails to control PPH, carboprost (15-methyl PGF2α, Hemabate) 250 µg IM, repeated up to 8 doses, is the next recommended uterotonic. It is contraindicated in asthma. Sublingual misoprostol can also be used but is considered second-line after carboprost in most guidelines. Carbetocin is used for prophylaxis, not treatment. Ergometrine is an alternative but causes vasoconstriction and is avoided in hypertension.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.