This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Gynaecology & Obstetrics
[{'content': '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: \nSelect and explain. \nA. Packing the uterus, B. Immediate hysterectomy, C. Bilateral internal iliac ligation, D. Injection of PGF 2∝', 'role': 'user'}, {'content': 'Answer: D \nExplanation: 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.\nStepwise Management of PPH is given in detail in the text kindly go through it\nNow coming on to the question:\n\nIn the question, the female suffering from PPH is Para 6 (i.e., family completed). She has received injection oxytocin and methergin.\n\nThe question asks:\n\nNext step in the Line of Management – Which should be I/M injection of PGF2α.\n\n“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”.\nRecent Advances in Obs and Gynae 24 Vol. edited by William Dunlop, p 93.\nIf the question would have said:\n• Best management – It would definitely be ‘hysterectomy’ in this case.', 'role': 'assistant'}]