What is the first-line uterotonic given after delivery to prevent postpartum hemorrhage?

• A. Oxytocin (usually given as an IV infusion or IM dose).
• B. Methylergonovine.
• C. Carboprost (Hemabate).
• D. Misoprostol.

Answer: (A)

Oxytocin is used first because it directly stimulates the uterus to contract, helping it stay firm after delivery and preventing atony, the leading cause of postpartum hemorrhage. When given promptly after birth—often as part of active management of the third stage of labor—it provides rapid, reliable uterine contraction with a short duration of action, and it generally has the best safety profile for most women. Other uterotonics can be effective but carry more risks or drawbacks: methylergonovine can raise blood pressure and isn’t suitable for hypertensive patients; carboprost can cause bronchospasm and GI side effects; misoprostol is a good option when oxytocin isn’t available but is associated with fever and more variable efficacy.