Etwell Mari

Member of the Australian College of OBGYN and ACEM, Australia

Title: The Paradigm shift in Severe PPH Management


There is need for a Paradigm shift in massive PostPartum Hemorrhage management approach from the ALS generic DR ABCDE to the SR. CABCDE or SR. MARCH-OT approach used in trauma care The SR. MARCH-OT approach is borrowed from the management of exsanguination hemorrhage in trauma care. This applies well to acute PPH hemorrhage control, hence this conceptual paper to change the ALSO and PROPMT algorithms in severe PPH management. The importance of skilled maternity professional and regular drills in managing massive PPH cases is paramount and cannot be over emphasized. The historical approach borrowed from the ACLS approach of following the DR. ABCDE algorithm does not address the points of emphasis in maneuvers that help quickly control the bleeding, “Closing the tap”. Most obstetric patients are young and have the physiological reserve to maintain the alertness, Airway and Breathing in the early stages of bleeding hence emphasis should be on closing the tap and replacing the red cells and clotting factors while not neglecting the support to Airway and ensuring patient is breathing.
Keywords: Hemorrhage; Maneuvers; Placenta


Etwell Mari is a Fellow of the Australian College of Remote and Retrieval Medicine. Dual specialty training in Obstetrics, Gynecology and Emergency Medicine. Master’s degree in Critical Care Medicine with special interest in Critical care in resource limited scenarios and critical care outside ICU (Remote retrieval and the prehospital Critical care).