Ergometrine is useful in the management of?

JSSH Staff Nurse - 2019

Obstetrics & Gynaecology

Easy

Appeared in: JSSH Staff Nurse - 2019

Explanation

Ergometrine is a uterotonic agent primarily indicated for the prevention and treatment of Postpartum Hemorrhage (PPH).
It works by inducing powerful and sustained contractions of the uterine myometrium.
This tetanic contraction compresses the intramyometrial blood vessels, effectively controlling bleeding from the placental site after delivery.
It is considered a second-line agent after oxytocin if bleeding persists.

Option A: Ergometrine is contraindicated in preeclampsia. Its vasoconstrictive properties can cause a dangerous spike in already elevated blood pressure.
Option C: Ergometrine is strictly contraindicated in eclampsia. The drug's hypertensive effect can worsen the condition and increase the risk of seizures.
Option D: Twin-to-twin transfusion syndrome is a complication of placental vascular anastomoses in monochorionic twins. Ergometrine has no therapeutic role in its management.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacological management of postpartum hemorrhage (PPH) as background academic context rather than a clinical decision trigger.
A nurse's primary safety check before administering ergometrine is to measure the patient's blood pressure. Administering it to a hypertensive patient can lead to a cerebrovascular accident (stroke) or eclamptic seizure.
Ergometrine is a key drug in the 'Active Management of the Third Stage of Labor' (AMTSL) protocol for preventing PPH, often used when oxytocin is unavailable or ineffective.
What if? If a patient with PPH has a documented history of hypertension or heart disease, the nurse must withhold ergometrine and anticipate an order for an alternative uterotonic like carboprost (a prostaglandin) or misoprostol.

How to Approach the Question

First, identify the drug in the question stem: 'Ergometrine'.
Recall the pharmacological class and primary action of ergometrine. It is an ergot alkaloid known for being a potent uterotonic (causes uterine contraction).
Consider its main clinical application in obstetrics, which is to contract the uterus firmly after delivery to stop bleeding.
Evaluate the given options. 'PPH' (Postpartum Hemorrhage) directly aligns with the drug's primary use.
Critically assess the other options as potential contraindications. Preeclampsia and eclampsia are hypertensive disorders, and since ergometrine raises blood pressure, it would be dangerous to use. Twin transfusion is an unrelated placental issue.
Conclude that ergometrine is useful for PPH and contraindicated in preeclampsia/eclampsia.

Concept Tested & Keywords

Q1RJsqla4sKRriUUaupRcm

E6 Pharmacology KD Tripathi Essentials 9e Part 2 p. 4-6

E6 Pharmacology Nurses Shanbhag 3e p. 242-244

E6 Pharmacology Katzung 16e p. 460-462