Which of the following medication is used in PPH (Post-Partum Hemorrhage)?

Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Obstetrics & Gynaecology

Easy

Appeared in: Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Explanation

Oxytocin is the first-line uterotonic drug recommended by the World Health Organization (WHO) for the prevention and treatment of postpartum hemorrhage.
It acts on specific receptors in the myometrium (uterine muscle) to induce powerful, rhythmic contractions.
These contractions effectively constrict the spiral arteries at the former placental implantation site, leading to hemostasis and control of bleeding.
It is a synthetic version of the natural hormone produced by the posterior pituitary gland and has a rapid onset of action (approximately 1 minute) when given intravenously.

Option B: Epinephrine is a catecholamine used primarily for anaphylaxis, cardiac arrest, or as a vasopressor to raise blood pressure. It does not have a primary role in stimulating uterine contractions to manage PPH.
Option C: Norepinephrine is a potent vasopressor used to treat life-threatening hypotension, often seen in septic shock. Its main effect is widespread vasoconstriction, not uterine contraction.
Option D: Dobutamine is an inotropic agent that increases the force of cardiac contraction. It is used in cases of cardiogenic shock or severe heart failure to improve cardiac output.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacological management of Post-Partum Hemorrhage (PPH) as background academic context rather than a clinical decision trigger.
A nurse's primary role in the active management of the third stage of labor includes the prompt administration of a prophylactic uterotonic, most commonly oxytocin, immediately after the delivery of the baby.
Post-administration, the nurse must diligently monitor uterine tone by palpating the fundus (it should be firm, not boggy), assess the amount of vaginal bleeding, and track the mother's vital signs to ensure the medication is effective and to detect any adverse effects.
Patient safety is paramount. Oxytocin should be administered as a dilute intravenous infusion or intramuscularly, never as a rapid IV bolus, as this can cause severe hypotension and cardiac arrhythmias.

How to Approach the Question

First, identify the core clinical problem presented in the question: the management of Post-Partum Hemorrhage (PPH).
Recall the most common cause of PPH, which is uterine atony (a soft, boggy uterus that fails to contract after delivery).
Understand that the primary treatment goal is to stimulate uterine contraction to compress the bleeding vessels.
Categorize the medication options based on their primary mechanism of action. Differentiate between uterotonics (drugs that contract the uterus) and catecholamines/vasopressors (drugs that affect the cardiovascular system).
Select the option that is a first-line uterotonic agent. Oxytocin is the standard choice.
Eliminate the other options by recognizing their roles in managing shock or cardiac emergencies, which are different from the primary treatment of uterine atony.

Concept Tested & Keywords

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E6 Obstetrics Williams pp. 11-26, 50-70