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Postpartum hemorrhage is an important cause of maternal morbidity and mortality; and is defined as blood loss of > 500 mL during a vaginal delivery and >1000 mL in a cesarean delivery. Uterine atony is the most common cause of postpartum hemorrhage and is a failure of the uterus to contract and provide hemostasis at parturition. Normally, oxytocin and prostaglandins are released and responsible for uterine contraction. First-line therapy for postpartum hemorrhage is oxytocin. All of the listed treatment choices are used to treat uterine atony; however, methylergonovine is contraindicated in patients with preeclampsia and hypertension. The criteria for preeclampsia without severe features includes a blood pressure ≥ 140/90 on 2 separate occasions at least 4 hours apart after 20 week’s gestation AND one of the following: Proteinuria (≥ 300 mg/24 H, protein-creatinine ratio ≥ 0.3 /n 1+ on urine dipstick specimen); Thrombocytopenia (platelet count <100,000/µL); Renal insufficiency (serum creatinine >1.1 mg/dL or doubling of serum creatinine); Impaired liver function (elevated liver transaminases to twice normal concentration); Pulmonary edema or cerebral/visual symptoms; Methylergonovine is an ergot alkaloid that is believed to cause tetanic uterine contractions via alpha-adrenergic receptor stimulation. Side effects of this medication include nausea, vomiting, arteriolar constriction, and possible thromboembolic sequelae. Of note, 15-methyl prostaglandin is contraindicated in patients with asthma given that one of its side effects includes bronchoconstriction. As an aside, magnesium sulfate is often used for seizure prophylaxis in preeclampsia, and also causes uterine relaxation, which may contribute to uterine atony. This patient meets the criteria of preeclampsia and treatment with methylergonovine should therefore be avoided.