This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Complication of 3rd Stage of Labour, Subject name: Gynaecology & Obstetrics
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? 
Select and explain. 
A. Insert B lynch suture, B. Ligate internal iliac artery, C. Perform hysterectomy, D. Transfuse factor Vila
C: Perform hysterectomy
Answer: C: Perform hysterectomy 
Explanation: 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.