Management of Severe Postpartum Hemorrhage

Integration with Hemorrhage Protocol

• The American College of Obstetricians and Gynecologists recommends concurrent use of tranexamic acid (1 gram IV within 3 hours of birth) to reduce maternal death from hemorrhage, which should be administered alongside uterotonic therapy 1, 2, 3
• Maintain a 1:1:1 to 1:2:4 ratio of packed red blood cells:fresh frozen plasma:platelets for massive transfusion, as recommended by the American College of Obstetricians and Gynecologists 1
• Monitor fibrinogen levels, targeting >200 mg/dL, as hypofibrinogenemia predicts severe postpartum hemorrhage, according to the American College of Obstetricians and Gynecologists 1

Surgical Interventions

• If bleeding persists after maximum carboprost dosing (2 mg total), proceed to surgical interventions, including uterine compression sutures, hypogastric artery ligation, or interventional radiology embolization, as recommended by the American College of Obstetricians and Gynecologists 1
• Consider recombinant factor VIIa only for posthysterectomy bleeding with failed standard therapy, given thrombosis risk (3% in case series) and high cost, according to the American College of Obstetricians and Gynecologists 1