A 28-year-old G1P0 at 40 weeks is induced with misoprostol (PGE1) 25 mcg vaginally. After the second dose, uterine tachysystole develops with late decelerations on CTG. The cervix is 5 cm dilated. What is the most appropriate immediate management?
- A Administer intravenous terbutaline ✓
- B Perform emergency cesarean section
- C Discontinue misoprostol and give intramuscular carboprost
- D Continue monitoring as tachysystole is self-limiting
Correct answer: A. Administer intravenous terbutaline
Explanation
Uterine tachysystole with late decelerations indicates fetal compromise from hyperstimulation. The immediate step is tocolysis with a rapid-acting agent such as terbutaline (beta-agonist) to relax the uterus and improve placental perfusion. Discontinuing the prostaglandin is necessary but insufficient alone when decelerations are present. Carboprost is a uterotonic and would worsen the situation. Emergency cesarean is reserved if decelerations persist despite tocolysis.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.