Postpartum Hemorrhage Management

Blood Count and Hemorrhage Assessment

The American Society of Anesthesiologists recommends that complete blood count (CBC) be collected to assess for anemia and blood loss, monitor hemoglobin/hematocrit levels, and evaluate platelet count in postpartum patients 1
Hemoglobin drop ≥2 g/dL or requiring transfusion of ≥2 units of RBCs is associated with significantly increased mortality risk, particularly in patients with cardiovascular disease, according to the American College of Cardiology 3
The Anesthesiology society suggests that visual assessment of blood loss should be combined with laboratory monitoring for optimal management of postpartum bleeding 1

The Critical Care society recommends that Prothrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT) be collected to evaluate the extrinsic/common and intrinsic/common coagulation pathways respectively 4
Fibrinogen level measurement is crucial as it's often the first coagulation factor to reach critically low levels during major bleeding, according to Praxis Medical Insights 2
Viscoelastic testing methods (TEG, ROTEM) may provide more rapid and comprehensive assessment of clot formation, strength, and breakdown than traditional coagulation tests, as suggested by the Critical Care society 4

The Anaesthesia society recommends that blood typing and cross-matching be performed to prepare for potential transfusion needs in case of significant postpartum hemorrhage 5
Having type-specific or cross-matched blood available reduces delays in transfusion when needed for hemodynamic instability, according to the Anaesthesia society 5

The American Journal of Obstetrics and Gynecology suggests that liver function tests assess for liver damage which may occur during pregnancy complications like preeclampsia or HELLP syndrome 6
Kidney function tests evaluate renal perfusion and function, which may be compromised during significant hemorrhage, according to the American Journal of Obstetrics and Gynecology 6
Monitoring organ function is essential as postpartum hemorrhage patients are at risk for multiorgan damage due to hypoperfusion, as recommended by the American Journal of Obstetrics and Gynecology 6

The Anesthesiology society recommends that routine postpartum CBC may not be necessary for all vaginal deliveries but should be performed when there are risk factors for excessive blood loss or patient symptoms is not applicable, however, visual assessment of blood loss should be combined with laboratory monitoring for optimal management of postpartum bleeding 1

Praxis Medical Insights warns that relying solely on conventional coagulation tests (PT, aPTT) may not correlate well with clinical bleeding 2
The Anesthesiology society advises against delaying treatment while waiting for laboratory results in cases of severe bleeding, and also against underestimating blood loss, which is common with visual assessment alone; quantitative measurement techniques are more reliable 1
Praxis Medical Insights suggests that traditional coagulation tests were not designed to monitor coagulopathy during active hemorrhage and may not reflect the dynamic clinical situation 2