Massive PPH may warrant all interventions except:: (A) Hysterectomy, (B) Thermal endometrial ablation, (C) Internal iliac aery ligation, (D) Balloon tamponade
Answer is B. 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