Consensus-based Recommendation 5.E12
Expert consensus	Level of consensus ++
Therapy: The goal is the reposition of the uterus and treatment of the symptoms of haemorrhagic shock. The following procedures must be carried out immediately after making the diagnosis in the order stated below: Stop administration of any uterotonic drug Call in experienced obstetrician and anaesthesiologist Ensure adequate intravenous access, volume substitution Make no attempt to remove the placenta (higher blood loss); the placenta must, where possible (placenta accreta), only be removed after repositioning 53 ,  54 Attempt to reposition the fundus (Johnsonʼs manoeuvre) If attempts at repositioning are unsuccessful, administer uterine relaxants (e.g. nitroglycerin 50 µg IV, betamimetics) and repeat the attempt to reposition the uterus with Johnsonʼs manoeuvre If repositioning attempts continue to be unsuccessful → perform laparotomy and Huntingtonʼs procedure, simultaneously with Johnsonʼs manoeuvre if necessary; if attempts are still unsuccessful, perform the Haultain procedure Administer uterotonics (e.g. oxytocin) after successful repositioning Provide antibiotic protection (e.g. cephalosporin or clindamycin)