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Chlamydia — USMLE Step 2 CK MCQ

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HardInfectious DiseasesChlamydiaUSMLE Step 2 CK

A patient has ongoing postpartum hemorrhage from uterine atony after vaginal delivery. Uterine massage, oxytocin and rectal misoprostol have been given. Blood loss is 1,200 mL and began 45 minutes ago. She has asthma and severe hypertension. Which pharmacologic adjunct should be given promptly while additional hemorrhage control proceeds?

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Correct answer: A — Give tranexamic acid 1 g intravenously

Tranexamic acid 1 g intravenously within 3 hours reduces death from obstetric hemorrhage and should accompany continued uterotonic, transfusion and mechanical escalation. Carboprost risks bronchospasm in asthma, and methylergonovine is contraindicated with severe hypertension. Repeating misoprostol alone is inadequate for major ongoing bleeding. Recombinant factor VIIa is a late rescue after conventional measures and correction of coagulopathy, not the next early treatment.

Reference: ACOG practice bulletin: postpartum hemorrhage: https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/10/postpartum-hemorrhage