4] This problem was noted as contributory in two deaths in the 2005-2007 NCCEMD report  in South Africa (SA) and in another three cases in the 2008 2010 report.
There has been much discussion of the NCCEMD findings concerning bleeding at CS in obstetric and anaesthetic forums.
The NCCEMD has produced guidelines on the prevention and treatment of blood loss at CS adapted from World Health Organization guidelines, Royal College of Obstetricians and Gynaecologists guidelines and recommendations from obstetric anaesthetic experts.
The NCCEMD advocates that the problem of maternal death be approached under the '5Cs':
Table 1 presents a guideline for a stepwise approach to use of uterotonics at CS that has been mutually agreed on between obstetricians and anaesthetists of the NCCEMD and is evidence based.