The decremental pattern of more complex interventions used demonstrates that the algorithm can provide a logical management pathway to reduce blood transfusions, hysterectomies, admissions to intensive care units, and maternal deaths.

Decelerations were the commonest CTG feature during the second stage of labor. The incidence of accelerations coinciding with uterine contractions was less than half in fetuses monitored using a fetal scalp electrode. Analysing the ECG waveform for the absence of 'p-wave' helps in differentiating MHR from FHR.

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P ostpartum hemorrhage (PPH) is the most common type of obstetric hemorrhage and is a life-threatening complication of childbirth. The mnemonic "HEMOSTASIS" provides the first letters of each step in an algorithm to be followed until maternal bleeding is stopped. The mnemonic is as follows: Help (request help from additional and senior staff); Establish etiology and ensure availability of blood; Massage the uterus; Oxytocin infusion and prostaglandins; Shift to OR; Tamponade test; Apply compression sutures; Systematic pelvic devascularization; Interventional radiology; Subtotal/total abdominal hysterectomy. This retrospective study investigated whether this algorithm was followed in a busy labor ward setting and whether it was effective in managing PPH.The study audit included all women who had massive primary PPH (total blood loss >1500 mL). Demographic and obstetric data were obtained on all women. To determine if Help was performed, cases were divided into those in which blood loss was 1500 to 200 mL and those in which blood loss was >2000 mL because at >2000 mL, all members of the obstetrical team are summoned. The data were not divided for any other analyses. Prolonged labor was defined as a first stage of >12 hours, a second stage of >3 hours, and a third stage of >30 minutes.Among the 5015 deliveries that were reviewed, 114 women had massive primary PPH, and there was adequate documentation for 95 of these women to be included as subjects for the present study. The median age of the women was 33 years, with 52 being nulliparous. Median gestational age at delivery was 40 weeks. Sixty-four (67.3%) of the women had blood loss of 1500 to 2000 mL and 31 (32.6%) lost >2000 mL. Median blood loss was 1775 mL. Help was requested (via code blue) in 84% of cases in which >2000 mL blood was lost. Eighty-eight (92.6%) of the women had at least 1 risk factor for PPH. The most prevalent were current cesarean delivery in 64.2%, prolonged labor in 35.8%, manual removal of the placenta in 25.3%, previous cesarean delivery in 16.8%, multiple pregnancies in 8.4%, instrumental vaginal delivery in 8.4%, placenta previa in 6.3%, fibroid uterus in 5.3%, prepartum hemorrhage in 4.2%, a history of PPH in 3.2%, infection/pyrexia in 2.1%, placenta accreta in 2.1%, and polyhydramnios in 1.1%. For the 61 cesarean deliveries, 50 were emergent and 11 were elective. Active management of the third stage of labor, along with uterine massage, was used in all cases. Manual removal of the placenta was the most common complication for the third stage (24 cases). Sixty-one women had uterine atony, the most frequent cause of PPH. All patients received intra-venous fluids, 25 received colloids, and 38 had blood transfusions. Medical treatment received by the patients included additional syntometrine in 27 women (28.4%), additional ergometrine in 10 (10.5%), 40 U oxytocin in 500 mL normal saline in all 95 (100%), parenteral prostaglandins in 29 (30.5%), and rectal misoprostol in 37 (38.9%). Twenty-four women required suturing of vaginal tears, incl...