Which medication is commonly used as a first-line uterotonic in the postpartum period to treat hemorrhage?

• A. Oxytocin (Pitocin).
• B. Ibuprofen (Motrin).
• C. Fentanyl (Sublimaze).
• D. Hemabate (Carboprost).

Answer: (A)

The key idea here is promoting uterine contraction to control postpartum hemorrhage. The best initial choice is oxytocin because it rapidly stimulates the uterus to contract, helping compress bleeding vessels after delivery. It acts on uterine oxytocin receptors to increase calcium in smooth muscle, producing effective contractions that reduce blood loss. Oxytocin is fast-acting, easy to titrate, and has a favorable safety profile, which is why it’s used routinely as the first-line uterotonic after delivery and as part of active management of the third stage of labor.

Ibuprofen and fentanyl do not affect uterine tone and are used for pain and analgesia, not for stopping hemorrhage. Hemabate can promote contractions as well, but it carries more significant side effects (diarrhea, vomiting, bronchospasm) and is typically reserved for when oxytocin alone isn’t sufficient or in specific clinical scenarios.