A 30-year-old G1P0 at 41 weeks is being induced with vaginal misoprostol. She suddenly develops uterine tachysystole (>5 contractions/10 min) with fetal bradycardia. The most appropriate immediate step is:

• A Administer IV oxytocin to accelerate labour
• B Administer subcutaneous terbutaline 0.25 mg for uterine relaxation
• C Proceed to immediate caesarean section without any medical intervention
• D Remove misoprostol if accessible, position patient, and administer oxygen ✓

Explanation

Uterine tachysystole with fetal heart rate changes in the context of misoprostol (PGE1 analogue) induction requires immediate cessation of the uterotonic agent if accessible (vaginal tablet can be removed), left lateral positioning to relieve aortocaval compression, oxygen administration, and IV fluid bolus. Subcutaneous terbutaline (tocolysis) is indicated if the FHR abnormality persists despite repositioning and removal of the agent. Immediate caesarean is premature before conservative measures are tried.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.