A 28-year-old primigravida at 40 weeks receives 25 micrograms of vaginal misoprostol for induction. Two hours later she has contractions occurring every 90 seconds lasting 75 seconds, and the CTG shows recurrent late decelerations with reduced variability. What is the most appropriate immediate next step?
- A Perform immediate caesarean section
- B Give a further half dose of misoprostol vaginally
- C Administer terbutaline 0.25 mg subcutaneously ✓
- D Start intravenous oxytocin at a high dose
Correct answer: C. Administer terbutaline 0.25 mg subcutaneously
Explanation
This is uterine hyperstimulation with fetal compromise following misoprostol. The first response is a uterine relaxant, classically terbutaline 0.25 mg subcutaneous, along with left lateral positioning, intravenous fluids and stopping the prostaglandin. Caesarean section is reserved for cases that fail to respond, and adding oxytocin or repeating misoprostol would worsen the hyperstimulation. Indian exam convention follows this same sequence of resuscitation then tocolysis.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.