How we treat: management of life-threatening primary postpartum hemorrhage with a standardized massive transfusion protocol
Article first published online: 20 AUG 2007
Volume 47, Issue 9, pages 1564–1572, September 2007
How to Cite
Burtelow, M., Riley, E., Druzin, M., Fontaine, M., Viele, M. and Goodnough, L. T. (2007), How we treat: management of life-threatening primary postpartum hemorrhage with a standardized massive transfusion protocol. Transfusion, 47: 1564–1572. doi: 10.1111/j.1537-2995.2007.01404.x
- Issue published online: 20 AUG 2007
- Article first published online: 20 AUG 2007
- Received for publication January 22, 2007; revision received April 29, 2007, and accepted May 8, 2007.
Management of massive, life-threatening primary postpartum hemorrhage in the labor and delivery service is a challenge for the clinical team and hospital transfusion service. Because severe postpartum obstetrical hemorrhage is uncommon, its occurrence can result in emergent but variable and nonstandard requests for blood products. The implementation of a standardized massive transfusion protocol for the labor and delivery department at our institution after a maternal death caused by amniotic fluid embolism is described. This guideline was modeled on a existing protocol used by the trauma service mandating emergency release of 6 units of group O D– red cells (RBCs), 4 units of fresh frozen or liquid plasma, and 1 apheresis unit of platelets (PLTs). The 6:4:1 fixed ratio of uncrossmatched RBCs, plasma, and PLTs allows the transfusion service to quickly provide blood products during the acute phase of resuscitation and allows the clinical team to anticipate and prevent dilutional coagulopathy. The successful management of three cases of massive primary postpartum hemorrhage after the implementation of our new massive transfusion protocol in the maternal and fetal medicine service is described.