The GDG noted that the application of these interventions requires training and that maternal discomfort and complications associated with these procedures have been reported.

• The GDG noted that conservative surgical approaches should be tried first. If these do not work, they should be followed by more invasive procedures. Compression sutures, for example, may be attempted as a first intervention; if these fail, then uterine, utero-ovarian and hypogastric vessel ligation may be tried. If life-threatening bleeding continues even after ligation, then a subtotal (otherwise known as supracervical) or total hysterectomy should be performed.
• The GDG acknowledged that the level of health care provider skills will have a role in the selection and sequence of the surgical interventions.