This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: General obstetrics, Subject name: Gynaecology & Obstetrics
A P5 female bleeds profusely after delivery of the placenta. You initiate IV fluids with Oxytocin. However, the patient continues to bleed over the next 10 min even after adequate uterine massage. On examination, she is tachycardic, hypotensive and the uterus is soft and boggy. What is the next step of management? 
Select and explain. 
A. Ligation of internal iliac aeries, B. Carry out balloon tamponade, C. Ligation of uterine aeries, D. Hysterectomy
B: Carry out balloon tamponade
Answer: B: Carry out balloon tamponade 
Explanation: The next step of management is to carry out balloon tamponade. When the uterine bleeding is unresponsive to uterotonic agents, bimanual uterine compression can be performed, IV lines must be placed and volume resuscitation staed A Bakri postpaum balloon may be inseed and inflated to tamponade the endometrial cavity. Other options mentioned are surgical methods of management, these are tried after all forms of medical management have failed. Ref: Williams Obstetrics 24th edition Pgno: 786