Which uterotonic is contraindicated in a patient with hypertension?

• A. Pítocin (oxytocin)
• B. Methergine
• C. Cytotec (misoprostol)
• D. Hemabate (carboprost)

Answer: (B)

In a patient with hypertension, you avoid uterotonics that can raise blood pressure. Methergine (methylergonovine) does exactly that: it causes potent vasoconstriction of vascular smooth muscle, which increases systemic vascular resistance and can trigger a dangerous rise in blood pressure after delivery. Because of this, it is contraindicated in hypertension (and in conditions like preeclampsia/eclampsia). In contrast, oxytocin and misoprostol promote uterine contractions with far less risk of acute BP elevation, making them safer choices in a hypertensive patient. Hemabate has other cautions (such as asthma due to bronchospasm) but hypertension is the main reason Methergine is avoided.