Introduction: More than half of all maternal deaths occur within 24 hours of delivery; most commonly from postpartum hemorrhage (PPH). Uterine atony is the most common cause of PPH. Majority of the cases respond to medical measures. However, few cases are refractory to medical measures and need further interventions. The present study was conducted to highlight uterus preserving management options for refractory cases of atonic PPH. Material and Methods: A retrospective review of all cases of atonic PPH refractory to medical measures was carried out in the department of Obstetrics and Gynecology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India from January 2014 to June 2015. Results: Out of 446 cases of PPH, uterine atonicity was responsible for 300 cases (67.26%). Of these 300 cases, 62 (20.67%) were refractory to medical measures and required further interventions. Foleys condom tamponade (FCT) was used in 34 patients, uterine compression sutures were used in 18 cases, and uterine devascularization was opted for in 7 cases. The success rate of FCT, uterine compression sutures and devascularization for controlling refractory atonic PPH was 85.29%, 94.44%, and 85.71% respectively. Conclusion: oleys condom tamponade should be tried to manage refractory atonic PPH following vaginal delivery. It is technically simple, easily available and highly effective modality. Doctors and health workers posted in peripheral health centres should be trained for uterine tamponade. So that referred patients do not reach higher centre in moribund state. In cases of refractory atonic PPH following cesarean section, both uterine compression sutures and FCT can be used depending on expertise of the operating person. The technique of compression sutures can be easily taught to senior residents and consultants. In cases of placenta previa with uterine atonicity, the preferred modalities are uterine devascularization with or without FCT.

Keywords: Atonic PPH; Intrauterine Tamponade; Uterine Compression Sutures, Uterine Devascularization.