AIIMS Delhi NO- 2019
Obstetrics & Gynaecology
Easy
Which of the following drug is preferrably administered immediately after delivery of baby?
Appeared in: AIIMS Delhi NO- 2019
Explanation
- Oxytocin is the recommended first-line uterotonic agent for the active management of the third stage of labor (AMTSL) to prevent postpartum hemorrhage (PPH), as per WHO guidelines.
- The standard and effective dose for routine prophylaxis is 10 International Units (IU) administered intramuscularly (IM) immediately after the delivery of the baby.
- It works by stimulating strong, rhythmic contractions of the uterus, which constricts the blood vessels at the former placental site, thereby minimizing blood loss.
Why Other Options Were Wrong
- Option B: A 20-unit dose is higher than the standard prophylactic dose. Higher doses are typically reserved for treating established postpartum hemorrhage (e.g., in an IV infusion), not for routine prevention.
- Option C: The dose of 2 mg is incorrect and dangerously high. The standard therapeutic dose of Methergine (methylergometrine) is 0.2 mg, which is ten times less than the dose stated in this option.
- Option D: This dose is twenty times the standard therapeutic dose and is extremely dangerous. It carries a high risk of severe side effects, including hypertensive crisis, stroke, or myocardial infarction.
Related Visual
Clinical Relevance
- Nursing practice connection: Safe nursing care depends on performing Pharmacological management of the third stage of labor to prevent postpartum hemorrhage in the correct sequence, documenting the action clearly, and monitoring for the expected response.
- Administering Oxytocin 10 IU IM immediately after delivery is a critical, high-impact nursing intervention to prevent PPH, the leading cause of maternal mortality worldwide.
- Nurses must be vigilant about the contraindications for Methergine, especially hypertension or pre-eclampsia. Administering it to a hypertensive patient can trigger a dangerous spike in blood pressure (hypertensive crisis).
- Accurate drug dosage is paramount. The Methergine doses in the incorrect options (2 mg and 4 mg) highlight the potential for catastrophic medication errors if the decimal point is misplaced from the correct 0.2 mg dose.
How to Approach the Question
- First, identify the clinical scenario: administration of a drug immediately after childbirth.
- Recognize that this relates to the Active Management of the Third Stage of Labor (AMTSL), a standard protocol to prevent postpartum hemorrhage (PPH).
- Recall the first-line drug recommended for AMTSL. This is Oxytocin.
- This immediately makes options A and B more likely than C and D.
- Compare the two Oxytocin doses. Recall that the standard prophylactic (preventive) dose is 10 units. Higher doses (like 20 units) are generally used for treatment of active bleeding, not routine prevention.
- Evaluate the Methergine options. Recall that Methergine is a second-line agent and has significant side effects and contraindications (like hypertension). More importantly, check the dosage. The standard dose is 0.2 mg. The options list 2 mg and 4 mg, which are dangerously high overdoses. This confirms they are incorrect.
Concept Tested & Keywords
- Concept Tested: Pharmacological management of the third stage of labor to prevent postpartum hemorrhage.
- Stem keywords: drug, administered, immediately after delivery
- Lead-in keywords: preferrably
- Negative lead-in flag: false
Question ID
QjW1mN7symWczbffE5u_bT
Reference Book
E6 Pharmacology KD Tripathi Essentials 9e Part 2 p. 4-6
E6 Obstetrics Williams p. 10-26
Practise the full AIIMS Delhi NO- 2019
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