What's the most appropriate step, is it doing ctg or keep the mother i

What's the most appropriate step, is it doing ctg or keep the mother in left lateral position or infusion fluid

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uterine hyperstimulation prostaglandin induction management IV fluids lateral position CTG

Question 24 — Answer: (a) Infusion of 0.9% NaCl Bolus

The marked answer is correct. Here's the reasoning:

Clinical Scenario Analysis

The patient has uterine hyperstimulation (tachysystole) caused by vaginal prostaglandin induction:

5 uterine contractions per 10 minutes (normal ≤5, but here associated with severe abdominal pain)
No remaining prostaglandin tablets in the vagina (so the drug cannot be removed)
The fetus is not yet known to be compromised (no mention of abnormal FHR)

Why IV Fluid Bolus (0.9% NaCl) First?

When uterine hyperstimulation occurs, the sequence of management per guidelines is:

Resuscitate uteroplacental circulation → IV fluid bolus (0.9% NaCl) improves maternal cardiac output and placental perfusion
Left lateral positioning (reduces aortocaval compression)
CTG monitoring (to assess fetal condition)
Tocolysis (e.g., terbutaline) if hyperstimulation persists

In this scenario:

The prostaglandin is already absorbed (no tablet remains) — you cannot remove it
The first and most immediate step to counteract hyperstimulation and improve uteroplacental oxygenation is an IV fluid bolus
This is also why stopping oxytocin is listed separately from prostaglandin management — you cannot "stop" an already-absorbed vaginal prostaglandin

Why Not the Others?

Option	Reason it's not the FIRST step
CTG (b)	Important but assessment comes after initial resuscitation; also no fetal distress is described yet
Oxytocin (c)	Contraindicated — this would worsen hyperstimulation
Left lateral (d)	Helpful adjunct, but IV fluid is the primary pharmacological resuscitation measure
EM-LSCS (e)	No evidence of fetal compromise to warrant emergency delivery yet

Key Teaching Point

In prostaglandin-induced hyperstimulation where the tablet has already dissolved/absorbed, the priority order is: IV fluid bolus → left lateral position → CTG → tocolysis (terbutaline) → consider delivery if fetal compromise persists.

The IV saline bolus directly addresses uteroplacental hypoperfusion — the core pathophysiological risk of hyperstimulation — making it the most appropriate immediate step.

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