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Difficulty: HardObstetric Complications

Match each obstetric clinical scenario to the most appropriate targeted pharmacologic intervention, taking into account the specific indications and contraindications for each patient.

  • Postpartum hemorrhage due to uterine atony in a normotensive patient with a history of severe persistent asthma; initial oxytocin therapy has failed.Methylergonovine
  • Postpartum hemorrhage due to uterine atony in a patient with preeclampsia and a current blood pressure of 165/110165/110 mmHg; initial oxytocin therapy has failed.Carboprost tromethamine
  • New-onset generalized tonic-clonic seizures in a patient at 3737 weeks gestation with severe headache, proteinuria, and a blood pressure of 180/115180/115 mmHg.Magnesium sulfate
  • Preterm labor at 3131 weeks gestation in a patient with a documented history of myasthenia gravis requiring tocolytic therapy.Nifedipine

Answer

The scenarios match to their respective interventions based on critical contraindications: the asthmatic patient receives methylergonovine, the hypertensive patient receives carboprost tromethamine, the eclamptic patient receives magnesium sulfate, and the myasthenia gravis patient receives nifedipine.
Correct matching relies on pairing the clinical presentation with the drug that avoids the patient's absolute contraindications while effectively treating the underlying obstetric emergency.

Step-by-Step Solution

1
Evaluate the first scenario involving postpartum hemorrhage in an asthmatic patient.
Identify that carboprost tromethamine is contraindicated due to its bronchoconstrictive effects. Select methylergonovine as the safe alternative.
Carboprost is a prostaglandin F2-alpha analogue that stimulates smooth muscle, including bronchial smooth muscle.
2
Evaluate the second scenario involving postpartum hemorrhage in a patient with severe hypertension.
Identify that methylergonovine is contraindicated as it can cause profound vasoconstriction and hypertensive crisis. Select carboprost tromethamine.
Methylergonovine is an ergot alkaloid that can lead to stroke or myocardial infarction in hypertensive patients.
3
Evaluate the third scenario involving a pregnant patient presenting with new-onset seizures and severe hypertension.
Diagnose eclampsia and select magnesium sulfate as the appropriate intervention.
Magnesium sulfate raises the seizure threshold and is the standard of care for eclamptic seizure termination and prophylaxis.
4
Evaluate the fourth scenario involving preterm labor in a patient with myasthenia gravis.
Recognize that magnesium sulfate is contraindicated and select the calcium channel blocker nifedipine for tocolysis.
Magnesium competitively inhibits calcium channels at the presynaptic motor nerve terminal, reducing acetylcholine release and exacerbating myasthenic weakness.

Key Concept

Pharmacological management of acute obstetric complications requires precise selection of uterotonics, anticonvulsants, and tocolytics by identifying strict maternal contraindications (e.g., asthma, hypertension, myasthenia gravis).
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Obstetric Complications

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