<prompt> 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 8050 mm of HgPR 130 beatsminuteWhat is the next step in management?Insert B lynch sutureLigate internal iliac arteryPerform hysterectomyTransfuse factor Vila  <response>: 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. 