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In the UK maternal deaths as a result of postpartum haemorrhage (PPH) numbered 1 in 60 000 births in the 1970s, falling to 1 in 200 000 births in the 1990s. However, in developing countries this figure may be as high as 1 in 2000–5000 births. The morbidity is 50 times more common than in developed countries. The improved figures from England and Wales are largely due to prophylactic use of oxytocics in the management of the third stage of labour and is similar to the figures of other developed countries. Confidential enquiries in the developed countries point to avoidable factors. Replacement of blood that is ‘too little and too late’ and ‘delay to initiate and perform definitive surgery’ when there is severe PPH that does not respond to medical management have been highlighted. The role of surgery and various surgical methods in the management of severe PPH is discussed.
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