Table 1 Summary of recent approaches to treatment of PPH (see original papers for illustrations of surgical techniques described)

Home-based treatment

 Family training program [16]

Clinical care protocols

 Risk assessment, measurement of blood loss, structured escalation and point-of-care viscoelastometric-guided early fibrinogen replacement [11]

Obstetric emergency team training

 Co-ordination of and communication during emergencies [15], PPH kits [18]

First line treatment

 E-MOTIVE: Early detection with calibrated drape plus ‘MOTIVE’ bundle [13]

Early diagnosis

 Reusable calibrated postpartum blood collection tray [14]

Appropriate uterotonics [8]

Tranexamic acid

 Intravenous (not oral [27]) tranexamic acid for PPH treatment [23], not caesarean prophylaxis [25]

Non-pneumatic anti-shock garment

 Recommended by WHO [3]

Refractory PPH, non-surgical

 Suction uterine tamponade devices [41, 42] versus balloon tamponade modifications [37]

Vaginal balloon tamponade [38]

Restrictive fluid resuscitation

 Permissive hypotension to reduce blood loss [43]

Massive transfusion protocols [44]

 Early fibrinogen [45] and cryoprecipitate [47] not proven

Point-of-care viscoelastic haemostatic assay-guided blood product transfusion [48]

Pelvic artery embolization

 Limited availability [53, 54]

Endovascular balloon occlusion of the aorta, common ileac arteries or internal ileac arteries [56]

External aortic compression

 Recommended by WHO [2]

Direct compression of the aorta during laparotomy

 Digital compression or various aortic clamps [65, 66]

Transvaginal haemostatic ligation procedures

 Various techniques described [67, 68]

Placental site sutures

 Purse string technique [69]

Uterine compression sutures

 Multiple variations described [71,72,73,74,75,76,77,78,79], including removable suture [80]

Innovative measures to control lower uterine segment haemorrhage associated with placenta accreta spectrum

 Many suture techniques described [81,82,83,84,85]

‘Sandwich’ technique

 B-LYNCH suture plus intrauterine balloon [86]

Uterine devascularization

 Stepwise approach [88]

Cell salvage

 Feasible but complex [90,91,92]

High frequency focussed ultrasound for placenta increta

Promising [93]

Veno-arterial extra-corporeal membrane oxygenation (VA-ECMO)

 Oxygenation pending cardiopulmonary recovery [94, 95]