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GTN Uterine Relaxation Caesarean — FRCA Final MCQ

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HardObstetric AnaesthesiaGTN Uterine Relaxation CaesareanFRCA Final

A 28-year-old woman (ASA I, 60 kg) at 37 weeks gestation with a twin pregnancy (twin 1 cephalic, twin 2 transverse) undergoes caesarean section under spinal anaesthesia. After delivery of twin 1, the uterus relaxes and twin 2's presentation changes to transverse lie with a prolapsed arm. The obstetrician requires uterine relaxation for internal podalic version. What is the most appropriate uterotonic reversal after successful version and delivery?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — GTN 200-400 mcg sublingual for relaxation, then oxytocin 5 IU slow IV after delivery

For acute uterine relaxation during caesarean section (e.g., for internal podalic version, fetal extraction from a contracted uterus), sublingual GTN 200-400 mcg (or IV GTN 50-100 mcg) provides rapid onset (30-60 seconds), short-duration uterine relaxation. After the procedure is complete and the baby delivered, oxytocin 5 IU slow IV should be administered promptly to restore uterine tone and prevent PPH. GTN's short duration (1-2 minutes) means uterine tone returns quickly. Alternative: IV terbutaline 250 mcg. Inhaled sevoflurane requires GA with its associated risks.

Reference: OAA – 2024 – QRH: Uterine relaxation; RCOG – 2019 – Twin pregnancy management