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

• Published in: Transfusion (Philadelphia, Pa.) Pa.), 2007-09, Vol.47 (9), p.1564-1572
• Main Authors: Burtelow, Matthew, Riley, Ed, Druzin, Maurice, Fontaine, Magali, Viele, Maurene, Goodnough, Lawrence Tim
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Pressure; Blood Transfusion - standards; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Body Temperature; Clinical Protocols; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency and intensive care: injuries, diseases due to physical agents. Diving. Drowning. Disaster medicine; Female; Humans; Intensive care medicine; Medical sciences; Middle Aged; Postpartum Hemorrhage - physiopathology; Postpartum Hemorrhage - therapy; Pregnancy; Transfusions. Complications. Transfusion reactions. Cell and gene therapy
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/j.1537-2995.2007.01404.x

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.