The following guidelines will help you to prevent or reduce the risk of ruptured uterus occurring in labouring women in your community:

• Use the partograph to follow the progress of a woman in labour, to ensure you get early warning if the labour is not progressing normally
• Refer women quickly if you suspect the labour is prolonged or obstructed (see referral criteria below).
• Advise all multiparous women with a potentially scarred uterus (because of complications with an earlier birth) to deliver in a health facility with the capacity for blood transfusion and caesarean delivery. Give the same advice to any woman who has had a uterine tumour removed.
• Explain to community members why it is important not to massage the uterus during labour, or apply pressure on the uterus to try to hasten delivery; ask them not to do this even though it is a traditional practice.
• Use uterotonic drugs to help deliver the placenta, but only after checking that the last fetus has been delivered.