BMJ Case Reports 2013; doi:10.1136/bcr-2013-009371

Exsanguinated uterus after massive atonic postpartum haemorrhage

  1. Ashish Pathak2,3,4
  1. 1Department of Obstetrics and Gynaecology, RD Gardi Medical College, Ujjain, Madhya Pradesh, India
  2. 2Department of Pediatrics, RD Gardi Medical College, Ujjain, Madhya Pradesh, India
  3. 3Department of Public Health Sciences, Global Health (IHCAR), Stockholm, Solna, Sweden
  4. 4Department of Women and Children's Health, International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden
  1. Correspondence to Dr Ashish Pathak, drashishp{at}


This article addresses issues related to pregnancy anaemia and late referral by a village birth attendant in resource poor setting in a central state of India. A young anaemic woman had labour onset at her village, a birth attendant tried to deliver her but failed. When she came to our hospital, had established septicaemia and absolutely non-reassurable uterine tone leading to intractable atonic postpartum haemorrhage. She died after 5 days because of coagulopathy and multiorgan failure. Huge budgets are being spent for the promotion of institutional deliveries but still the maternal mortality ratio has not reduced. The epidemiology of childbirth, social awareness for safe labour and administrative lethargy towards implementation of government programmes have not changed. The tertiary care—blood and components—multidisciplinary approach could not prevent the death of an anaemic woman. Unless there is a grassroot level change in the healthcare delivery system at the village level, the scenario might not change.

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