A 35-year-old grand multipara starts bleeding profusely soon after delivery. Following steps were done:* IV lines secured* Resuscitation commenced* Oxytocins given* Balloon tamponade doneWhile these steps were being done 4 units of blood were transfused. But still her vitals are:BP = 80/50 mm of HgP/R = 130 beats/minuteWhat is the next step in management?

Ans. is c, i.e. Perform hysterectomyFriends, management of PPH has to individualised in each case. In this question, oxytocin and balloon tamponade have failed incontrolling PPH. Inspite of giving 4 units of blood, her vitals are unstable.She is a grand multipara [?] instead of trying any conservative surgery like B lynch suture or ligation of internal iliac artery.I will straight away perform hysterectomy.