title: Exsanguinated uterus after massive atonic postpartum haemorrhage.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynaecology, RD Gardi Medical College, Ujjain, Madhya Pradesh, India.
authors.forename: Kalpana V
authors.initials: KV
authors.lastname: Mahadik
authors.forename: M B
authors.initials: MB
authors.lastname: Swami
authors.forename: Neha
authors.initials: N
authors.lastname: Pandey
authors.forename: Ashish
authors.initials: A
authors.lastname: Pathak
mesh_terms: D000328:Adult; D058734:Exsanguination / Q000209:etiology*; D005260:Female; D006801:Humans; D006473:Postpartum Hemorrhage; D012720:Severity of Illness Index; D014599:Uterus / Q000098:blood supply*