title: Postpartum hemorrhage: state and national response.
abstract: OBJECTIVE
  The rise in maternal mortality has raised a significant concern for epidemiologists and providers. One of the most preventable and frequent causes of maternal death is hemorrhage-related events. Most providers of obstetrical care see such complications on a frequent basis, and the costs in maternal lives and blood usage have become a universal concern. As a result, a number of important responses by state and national groups have taken place to address these preventable bad outcomes.
  
  
  RESULTS
  A number of well designed step-by-step protocols have had success in preventing morbidity and mortality. Expert panels have applied toolkits, including risk screening, medication protocols, transfusion protocols and clinical procedures, to either abate or mitigate the effects of uterine bleeding. The usage of these 'toolkits' has allowed institutions to lower blood utilization and improve maternal outcomes in various care settings. Readiness of institutions to rapidly respond in an organized fashion prevents many of the secondary complications.
  
  
  CONCLUSIONS
  Postpartum hemorrhage toolkits and their application are excellent examples of system readiness improvement to address a specific obstetrical problem. Widespread adoption should lead to a reduction in maternal mortality and morbidity.
authors.affiliation: aMemorialCare Health System, Fountain Valley bDivision of Maternal Fetal Medicine, University of California, Irvine, California, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Lagrew
mesh_terms: D006801:Humans; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology