title: Transfusion and coagulation management in major obstetric hemorrhage.
abstract: OBJECTIVE
  Major obstetric hemorrhage is a leading cause of maternal morbidity and mortality. We will review transfusion strategies and the value of monitoring the maternal coagulation profile during severe obstetric hemorrhage.
  
  
  RESULTS
  Epidemiologic studies indicate that rates of severe postpartum hemorrhage (PPH) in well resourced countries are increasing. Despite these increases, rates of transfusion in obstetrics are low (0.9-2.3%), and investigators have questioned whether a predelivery 'type and screen' is cost-effective for all obstetric patients. Instead, blood ordering protocols specific to obstetric patients can reduce unnecessary antibody testing. When severe PPH occurs, a massive transfusion protocol has attracted interest as a key therapeutic resource by ensuring sustained availability of blood products to the labor and delivery unit. During early postpartum bleeding, recent studies have shown that hypofibrinogenemia is an important predictor for the later development of severe PPH. Point-of-care technologies, such as thromboelastography and rotational thromboelastometry, can identify decreased fibrin clot quality during PPH, which correlate with low fibrinogen levels.
  
  
  CONCLUSIONS
  A massive transfusion protocol provides a key resource in the management of severe PPH. However, future studies are needed to assess whether formula-driven vs. goal-directed transfusion therapy improves maternal outcomes in women with severe PPH.
authors: aDepartment of Anesthesiology bDepartment of Pathology cDepartment of Medicine, Stanford University School of Medicine, Stanford, California, USA.
authors: Alexander J
authors: AJ
authors: Butwick
authors: Lawrence T
authors: LT
authors: Goodnough
mesh_terms: D000328:Adult; D001777:Blood Coagulation; D001778:Blood Coagulation Disorders / Q000175:diagnosis; D001803:Blood Transfusion / Q000379:methods*; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use; D006801:Humans; D007743:Labor, Obstetric; D006473:Postpartum Hemorrhage / Q000097:blood* / Q000628:therapy*; D011247:Pregnancy
chemical_list: D005340:Fibrinogen