Which medication is primarily used if uterine atony does not respond to massage?

Oxytocin is the primary medication administered for uterine atony that does not improve with uterine massage. This medication acts on uterine smooth muscle cells to enhance contractions, helping to restore uterine tone and reduce the risk of postpartum hemorrhage associated with uterine atony. Oxytocin is typically the first-line treatment in such situations due to its ability to quickly promote uterine contraction.

When uterine atony is present, effective management is crucial to ensure maternal safety and prevent excessive blood loss. While other medications can be used in the management of uterine atony, oxytocin is often the initial choice because of its known efficacy and safety profile during active labor and the immediate postpartum period.

In contrast, although Hemabate and Methergine may also be employed for uterine atony, they are generally considered second- or third-line options, with Hemabate being more commonly indicated if oxytocin is ineffective or the patient has specific contraindications to oxytocin. Magnesium sulfate is not used in this context, as it primarily serves to prevent seizures in conditions like preeclampsia and assists with neuroprotection for the fetus rather than facilitating uterine contractions.