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How we treat: management of life-threatening primary postpartum hemorrhage with a standardized massive transfusion protocol

Authors

  • Matthew Burtelow,

    1. From the Department of Pathology, Department of Anesthesiology, and Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California.
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  • Ed Riley,

    1. From the Department of Pathology, Department of Anesthesiology, and Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California.
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  • Maurice Druzin,

    1. From the Department of Pathology, Department of Anesthesiology, and Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California.
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  • Magali Fontaine,

    1. From the Department of Pathology, Department of Anesthesiology, and Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California.
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  • Maurene Viele,

    1. From the Department of Pathology, Department of Anesthesiology, and Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California.
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  • Lawrence Tim Goodnough

    1. From the Department of Pathology, Department of Anesthesiology, and Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California.
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Lawrence Tim Goodnough, MD, Department of Pathology, Stanford University Medical Center, 300 Pasteur Drive, Room H-1402, Stanford, CA 94305-5626; e-mail: ltgoodno@stanford.edu.

Abstract

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.

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