An update on the use of massive transfusion protocols in obstetrics.
Obstetrical hemorrhage remains a leading cause of maternal mortality worldwide. New concepts involving the pathophysiology of hemorrhage have been described and include early activation of both the protein C and fibrinolytic pathways. New strategies in hemorrhage treatment include the use of hemostatic resuscitation, although the optimal ratio to administer the various blood products is still unknown. Massive transfusion protocols involve the early utilization of blood products and limit the traditional approach of early massive crystalloid-based resuscitation. The evidence behind hemostatic resuscitation has changed in the last few years, and debate is ongoing regarding optimal transfusion strategies. The use of tranexamic acid, fibrinogen concentrates, and prothrombin complex concentrates has emerged as new potential alternative treatment strategies with improved safety profiles.
Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX; Department of Anesthesiology, The University of Texas Medical Branch at Galveston, Galveston, TX. Electronic address: ldpachec@utmb.edu.
Luis D
LD
Pacheco
Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX.
George R
GR
Saade
Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX.
Maged M
MM
Costantine
Department of Obstetrics and Gynecology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
Steven L
SL
Clark
Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX.
Gary D V
GD
Hankins
D001803:Blood Transfusion / Q000379:methods* / Q000592:standards; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D005260:Female; D005440:Fluid Therapy / Q000379:methods / Q000592:standards; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D012151:Resuscitation / Q000379:methods / Q000592:standards; D065227:Transfusion Reaction
D006490:Hemostatics
hemostatic resuscitation; massive transfusion; obstetrical hemorrhage