Massive PPH may warrant all interventions except:

Thermal endometrial ablation is not used in the management of massive PPH. Mechanical methods for failed medical management: Bimanual compression Uterine packing under anaesthesia Bakri balloon: Maximun filling volume is 500 ml Shivkars Pack: Condom inflated with saline and tied to a nasogastric tube. Surgical methods for failed mechanical methods: B Lynch suture application Block sutures/multiple squares/Hayman/Cho square/Gunshella suture Uterine and ovarian aery ligation Internal iliac aery ligation Hysterectomy (if all the above fails, as a last reso) Note: Thermal endometrial ablation is used to treat abnormal uterine bleeding. Ref: Williams Ostetrics 24th edition Pgno: 482