Obstetrics Haemorrhage(OH) comprises one of the triads of causes for maternal mortality all over the world. It consists of both antenatal hemorrhage (APH) postpartum hemorrhage (PPH). As commonly stated APH weakens and PPH kills. Coming to the management of OH, it depends on the specific diagnosis. The management of APH depends on the patient condition and gestation age. A massive APH would need expedite termination of the pregnancy, mostly with surgical means and use of blood and blood products transfusion.

After delivery of the placenta, PPH is very likely in patients with APH. The current management protocol for PPH comprises of a bundle approach using the E-MOTIVE means. The abrravation represents as follows

E: Quick evaluation of the case to reach at the correct diagnosis

M: Uterine Massage O: use of Oxytocin T: use of Tranexamic acid IV: Intavenous Crystalloids and E: Examination of the genital truct.

If the above management fails , we proceed with surgical management, which includes conservative surgical management and definitive surgical management. The conservative surgical management includes; Uterine compressive sutures, vessel ligations,amd hypogastric artery libations. The definitive surgical procedure is hysterctomy( total or partial hysterctomy).

It seems to me that continued presence of PPH at vaginal birth id financially motivated. 14 years ago a protocol that completely eliminates PPH was published: and bo

https://www.researchgate.net/publication/363216491_Novel_Third_Stage_Protocol_wwwyoutubecomwatchvAAJPW4p6rzUReduces_Postpartum_Hemorrhage_at_Vaginal_Birth

If there was a desire to eliminate PPH, just deliver the placenta by 3 minutes PP in squatting.

@Judy, I would agree with you in a sense that, in the management of PPH, the world's budget should have been invested in the most prevalent areas of the world with PPH. We know that, due amount of money is invested in rare diseases, which I have no objection with, however , the most killer diseases like PPH are not given due attentions.

Identifying the exact cause of PPH before dealing with the situation is most importanT. Training in Advanced and basic life support has to be included in the curriculum so that experts and hospital staff can handle such emergencies successfully and the most important thing is each labour patient should be hospitalised for delivery and home delivery should be strictly prohibite.

@desta,your approach is indeed awesome and very practical. Indeed,given enough financial inclusions that would facilitate the training,knowledge and skills reinforcement among health workers,and implementation of EMOTIVE strategy is a sure way to elimination of OH

I totally agree with Smritika Toward, recognizing the mother at risk and timely response is a cornerstone in dealing with PPH, however, it's still challenging in poor resource countries like mine in Uganda where where all the 3delays are still at peak

End PPH: https://www.researchgate.net/publication/363216491_Novel_Third_Stage_Protocol_wwwyoutubecomwatchvAAJPW4p6rzUReduces_Postpartum_Hemorrhage_at_Vaginal_Birth