During active management of labour injection ergometrine is contraindicated in which of the following conditi… - NHM UP Staff Nurse-2021 Shift-1st

NHM UP Staff Nurse-2021 Shift-1st

Pharmacology

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Appeared in: NHM UP Staff Nurse-2021 Shift-1st

Explanation

Severe eclampsia is a hypertensive disorder of pregnancy where blood pressure is critically elevated.
Ergometrine is a potent vasoconstrictor, meaning it narrows blood vessels throughout the body.
Administering ergometrine in a patient with severe eclampsia would cause a further dangerous spike in blood pressure.
This acute rise in blood pressure can lead to life-threatening complications like cerebral hemorrhage (stroke) or trigger more eclamptic seizures.
Therefore, ergometrine is absolutely contraindicated in severe eclampsia and other hypertensive states.

Option A: Primigravida simply means a woman is pregnant for the first time. It is a demographic status, not a medical condition, and does not pose any contraindication to the use of ergometrine.
Option C: Prolonged labor increases the risk of uterine atony (failure of the uterus to contract after delivery), which is a major cause of postpartum hemorrhage. Ergometrine is a uterotonic agent used to prevent or treat uterine atony, making it an indication, not a contraindication.
Option D: This option is incorrect because a valid and critical contraindication, severe eclampsia, is listed as option B.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacology: Contraindications of Uterotonic Agents as background academic context rather than a clinical decision trigger.
A critical nursing responsibility before administering ergometrine is to check the patient's blood pressure. Failure to do so can have fatal consequences in a hypertensive patient.
This highlights the importance of knowing both the indications and contraindications of all medications administered, especially in high-stakes environments like the labor room.
What if? If a patient is experiencing postpartum hemorrhage but also has a blood pressure of 160/110 mmHg, the nurse should anticipate an order for Oxytocin or other alternatives like Carboprost or Misoprostol, and question any order for ergometrine.

How to Approach the Question

First, identify the drug in the question: Ergometrine.
Recall the primary mechanism of action and the most significant side effect of ergometrine. Its main action is uterine contraction, but its critical side effect is vasoconstriction, leading to increased blood pressure.
Next, analyze each option to see which condition would be dangerously worsened by this side effect.
Evaluate 'Primigravida': This is a first pregnancy, not a disease. It's not relevant to the drug's side effect.
Evaluate 'Severe eclampsia': This is a condition defined by extremely high blood pressure and risk of seizures. Increasing blood pressure further would be life-threatening. This is a strong candidate for the correct answer.
Evaluate 'Prolonged labour': This increases the risk of bleeding, for which ergometrine is a treatment. It is an indication, not a contraindication.

Concept Tested & Keywords

Concept Tested: Pharmacology: Contraindications of Uterotonic Agents
Stem keywords: active management of labour, injection ergometrine, contraindicated
Lead-in keywords: which of the following conditions

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