Fig. 1

Three-step procedure for early detection of intractable postpartum hemorrhage. Step 1 (left): Caudal compression of the uterine fundus to expel clots from the birth canal using fingers. Step 2 (middle): wiping vaginal blood with gauze following inspection with a Cusco vaginal speculum. Step 3 (right): immediate measurement of the time interval for bleeding to appear at the vagina through external os after Step2.