A 30-year-old woman para 6 delivers vaginally following normal labour with spontaneous delivery of an intact placenta. Excessive bleeding continues, despite manual exploration, bimanual massage, intravenous oxytocin and adminis-tration of 0.2 mg methergin IV, which one of the following would be the next step in the management of this patient:

Management of Postpartum Hemorrhage follows an algorithm, but it is important to understand that PPH is an obstetrical emergency where resuscitative measures, specific measures as well as investigations should all be done at the same time. Stepwise Management of PPH is given in detail in the text kindly go through it Now coming on to the question: In the question, the female suffering from PPH is Para 6 (i.e., family completed). She has received injection oxytocin and methergin. The question asks: Next step in the Line of Management – Which should be I/M injection of PGF2α. “PGF2α —It is a second line agent for uterine atomy. This is 80-90% effective in stopping PPH in cases that are refractory to oxytocin and ergometrine”. Recent Advances in Obs and Gynae 24 Vol. edited by William Dunlop, p 93. If the question would have said: • Best management – It would definitely be ‘hysterectomy’ in this case.