Hariyana-CHO-2021
Obstetrics & Gynaecology
Easy
What is total dose of tab. misoprostol given for prevention of PPH?
Appeared in: Hariyana-CHO-2021
Explanation
- The standard recommended dose of misoprostol for the prevention (prophylaxis) of postpartum hemorrhage (PPH) is 600 mcg.
- This is administered as a single oral dose immediately after the birth of the baby.
- Misoprostol is a prostaglandin E₁ analogue that stimulates powerful uterine contractions, which helps to control bleeding from the placental site.
- It is typically used for PPH prevention in settings where the first-line drug, oxytocin, is not available.
- The 600 mcg dose is usually given as three 200 mcg tablets.
Why Other Options Were Wrong
- Option A: A dose of 200 mcg is considered sub-therapeutic and is not sufficient to provide effective prophylaxis against PPH.
- Option B: While some guidelines mention a range of 400-600 mcg for PPH prevention, 600 mcg is the more commonly cited and recommended standard dose by organizations like the WHO.
- Option D: A dose of 800 mcg is not used for routine prevention of PPH due to a higher risk of side effects.
Related Visual
Clinical Relevance
- Nursing practice connection: Knowing Pharmacological management for the prevention of Postpartum Hemorrhage (PPH) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
- Knowing the correct dosage of uterotonics is critical for patient safety. Administering a sub-therapeutic dose (like 200 mcg) can lead to preventable hemorrhage, while an excessive prophylactic dose (like 800 mcg) can cause significant side effects like hyperpyrexia, shivering, and gastrointestinal distress.
- Nurses must be aware of the first-line (oxytocin) and second-line (misoprostol) agents for PPH prevention and the specific clinical scenarios for their use, such as the unavailability of refrigeration for oxytocin in some resource-limited settings.
- What if? If a patient has a history of asthma, the nurse should be cautious. While misoprostol is generally safe, other prostaglandins can cause bronchospasm. Ergometrine is contraindicated in patients with hypertension.
How to Approach the Question
- First, identify the keywords in the question: 'total dose', 'misoprostol', 'prevention', and 'PPH'.
- The key differentiator is 'prevention'. This distinguishes the question from one asking about the 'treatment' of PPH.
- Recall the standard pharmacological protocols for PPH prophylaxis.
- Remember that oxytocin is the first-line drug, but misoprostol is a crucial second-line agent, especially in resource-limited settings.
- Access your knowledge of the specific dosage for misoprostol when used for prevention. The standard dose is 600 mcg orally.
- Evaluate the given options. 200 mcg is too low. 800 mcg is the treatment dose. 400 mcg is on the lower end of the prophylactic range, while 600 mcg is the standard recommended dose. Therefore, 600 mcg is the best answer.
Concept Tested & Keywords
- Concept Tested: Pharmacological management for the prevention of Postpartum Hemorrhage (PPH).
- Stem keywords: total dose, misoprostol, prevention, PPH
- Lead-in keywords: What is
Question ID
Q8VrHzia8oHGythpSAkze5
Reference Book
E6 Obstetrics Williams p. 12-27
Practise the full Hariyana-CHO-2021
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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