Postpartum haemorrhage and emergencies: misoprostol shivering and pyrexia: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Postpartum haemorrhage and emergencies: misoprostol shivering and pyrexia

Sample item

Sublingual misoprostol 800 mcg is given for atonic postpartum haemorrhage. Within an hour she has marked shivering and a temperature of 39 degrees C. The uterus is firm, lochia is not offensive, and she has not been transfused. What is the most likely explanation?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. A dose-related, self-limiting prostaglandin effect on thermoregulation

Shivering and pyrexia are the commonest side effects of misoprostol and increase with dose and sublingual route. They settle in a few hours and need only reassurance and an antipyretic. The firm uterus, clean lochia and short time course argue against infection.

Option by option

  • A. Amniotic fluid embolism with an inflammatory response

    Amniotic fluid embolism presents with collapse, hypoxia and coagulopathy, not isolated fever.

  • B. Early chorioamnionitis needing intravenous antibiotics

    Chorioamnionitis would show prior fever, fetal tachycardia or offensive liquor, which are absent.

  • C. A dose-related, self-limiting prostaglandin effect on thermoregulation (correct)

    Correct. Misoprostol causes dose-related shivering and fever that resolve spontaneously.

  • D. Retained placental tissue with early sepsis

    Retained tissue with sepsis would not appear within an hour of the drug and would give offensive lochia.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is C, A dose-related, self-limiting prostaglandin effect on thermoregulation. Shivering and pyrexia are the commonest side effects of misoprostol and increase with dose and sublingual route.

Why is "Amniotic fluid embolism with an inflammatory response" not the answer?

Amniotic fluid embolism presents with collapse, hypoxia and coagulopathy, not isolated fever.

Why is "Early chorioamnionitis needing intravenous antibiotics" not the answer?

Chorioamnionitis would show prior fever, fetal tachycardia or offensive liquor, which are absent.

Why is "Retained placental tissue with early sepsis" not the answer?

Retained tissue with sepsis would not appear within an hour of the drug and would give offensive lochia.

What concept does this question test?

It tests Postpartum haemorrhage and emergencies: misoprostol shivering and pyrexia in OBG. They settle in a few hours and need only reassurance and an antipyretic. The firm uterus, clean lochia and short time course argue against infection.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Postpartum haemorrhage and emergencies: misoprostol shivering and pyrexia?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.