<s>[INST] context: Methyl ergometrine Cardiac patients' should not receive ergotamine because these agents cause significant vasoconstriction and elevation of blood pressure which can be deleterious to the patient. Also know, In healthy women, an intravenous bolus of 10 units of oxytocin caused a transient but marked fall in aerial blood pressure that was followed by an abrupt increase in cardiac output. These hernodynamic changes could be dangerous to women already hypovolemic from hemorrhage or who had cardiac disease that limited cardiac output. The same danger is present for women with right to left cardiac shunts because the decrease in systemic resistance would fuher increase the shunt. So, - Oxytocin should not be given intravenously as a large bolus, but rather as a much more dilute solution by continuous intravenous infusion or as an intramuscular infection. Management of cardiac patient during pregnancy Antepaum Bed rest The most impoant measure for attenuating the impact of pregnancy on diseased hea is bed rest. Bed rest increases the venous return to the hea, improves renal perfusion, induces diuresis and promotes elimination of water. Dietory salt restriction It helps to prevent excess retention of sodium and water. Diuretics It should be given to cardiac pregnant patient if moderate restriction in sodium intake is insufficient to limit the normal intravascular volume expansion that occurs during gestation. Prophylactic digitalization It is commonly used in patients with severe hea disease who are not in ove congestive failure. During labour and delivery The pregnant cardiac patient should always labor and deliver in lateral supine position to avoid hemodynamic impairment caused by dorsal decubitus position. Effective pain relief during labour with morphine. Continuous monitoring with pulse oximetry. Restriction of i.v. fluids to 75 ml/hr (Almost all cardiac patients in labour should be kept on the dry side). Antibiotic prophylaxis (This is given in patients with congenital or acquired hea lesions). Thrombosis prophylaxis. Patient should be placed in sitting position after delivery. This is done to avoid pulmonary edema (sitting will increase venous pooling in the lower extremities and decrease the venous return to the hea). [/INST] question: Drug contraindicated in patient with rheumatic hea disease in PPH is | options: A: Oxytocin infusion B: Methyl ergometrine C: Misoprostol D: Carboprost | answer: B </s>