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Question preview · UKMLA

A 30-year-old woman has continuing postpartum haemorrhage 45 minutes after a vaginal birth at 39 weeks. Blood loss is 1,600 mL and rising. Despite bladder emptying, uterine massage, an oxytocin infusion, ergometrine, carboprost and intravenous tranexamic acid, her uterus remains poorly contracted. Examination under anaesthetic confirms an empty uterus, and a vaginal tear has been repaired. The obstetric and anaesthetic teams continue resuscitation, including blood products. Which intervention should be considered before proceeding directly to surgical haemorrhage control?

  1. A. Uterine compression sutures
  2. B. Bilateral uterine artery ligation
  3. C. Intrauterine balloon tamponade
  4. D. Internal iliac artery ligation
  5. E. Hysterectomy

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