The stepwise rapid succession of medical followed by surgical interventions can stop or minimize the bleeding and correct the blood loss and prevent the cascade of events that lead to massive blood loss, hysterectomy, admission to ICU and deaths. ‘Too little, too late’ has been highlighted in successive confidential enquiries into maternal deaths in the UK; and is tackled by the use of the mnemonic ‘HAEMOSTASIS’. Give oxygen, adequate fluids, blood and blood products. No response to oxytocin or, ergometrine warrants infusion of oxytocin to keep the uterus contracted to allow clotting of uterine vessels. Next step is bimanual uterine massage and prostaglandins (parenteral PGF or misoprostol PG E1 orally or sublingually). Blood loss could be about 70 ml/min when the uterus relaxes and hence a 14 Gauge needle to give fluids rapidly should be used X 2 lines. Tranexamic acid, an antithrombolytic prevents the clot from lysing. An antishock garment, which squeezes the blood into the circulation and also has a compressive effect on the uterus, could be tried. Consumptive coagulopathy, lack of clotting factors, activation of fibrinolysis, large volumes of fluids, metabolic acidosis and hypothermia aggravates the situation and is controlled by fibrinogen and clotting factors. Shock is proportionate to blood loss – mild 15%, moderate 30%, and severe 45%. Transfusion of one unit packed red blood cells to unit plasma as opposed to four packed cells to one unit plasma results in a 60 to 70% reduction in mortality in war injury victims -same principle after blood loss of > 2L of blood loss is useful. Freeze dried fibrinogen concentrate that can be reconstituted may be an alternative. Platelet transfusion may be needed but this is rare. Failure to arrest haemorrhage by medical therapy should be followed by a ‘Tamponade Test’. It will only work when there is no coagulopathy. Sengstaken, Rusche, or Cooke’s catheter can be inserted into the uterus and filled with warm saline/ water bleeding completely stops. If bleeding stops the balloon can be taken out in 6 hours. Patient should have broad-spectrum antibiotics and an oxytocin infusion. Vital parameters, fundal height and bleeding per vagina should be monitored. If the test is going to be effective it will be known within 5 minutes. If the tamponade fails to stop the bleeding, a laparotomy should be performed and compression sutures (B- lynch or 2 to 5 vertical) should be employed. Failure of compression sutures should lead to systematic devascularisation by tying the infundibulopelvic and uterine vessels and/or anterior branch of the internal iliacs. Arterial embolisation using radiological guidance can be tried where facilities exist. Failure to arrest haemorrhage or deterioration of general condition of the patient should prompt sub-total or total hysterectomy. The recent research – WOMAN trial consisting of 20,000 women has proven that a clot stabilizer Tranexamic acid given within three hours of delivery would reduce maternal deaths due to bleeding without any thrombo embolic risks. The long acting heat stable duratocin (half-life approx. 80 minutes) may be better than syntocinon that has a half-life of 4 mins. The CHAMPION trial that would recruit 30,000 women may revolutionize the medications we may give. If blood transfusion is needed, one packed cells to one plasma compared with four red cells to plasma may help to save many lives and reduce morbidity. The management of placenta accrete may be best with a ‘Triple P procedure’ pioneered at St George’s Hospital may find more acceptance as it excises the placenta with part of myometrium and allows reconstruction and retention of the uterus. New regime of drugs and simple technology may help many women to survive and retain their uterus and reduce overall morbidity.