RT Journal Article SR Electronic T1 Exsanguinated uterus after massive atonic postpartum haemorrhage JF BMJ Case Reports FD BMJ Publishing Group Ltd SP bcr2013009371 DO 10.1136/bcr-2013-009371 VO 2013 A1 Mahadik, Kalpana V A1 Swami, M B A1 Pandey, Neha A1 Pathak, Ashish YR 2013 UL http://casereports.bmj.com/content/2013/bcr-2013-009371.abstract AB 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.