Postpartum Hemorrhage: Management of Massive Transfusion

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In women with postpartum hemorrhage, the need to transfuse a large amount of blood products is frequent. The ABCD of massive transfusions—Assessment/Activation, Blood products, Complications, and Drugs—can help manage this complex situation. There needs to be a defined method to activate the massive transfusion protocol and a well-defined means to assess the coagulation status of the patient by either traditional laboratory tests or point of care methods such as thromboelastography. Recent data supports more aggressive use of plasma in the massively transfused patient. Obstetricians need to be vigilant in assessing compilations, especially hypothermia. Given the increased use of antithrombotic drugs in bleeding patients, one needs to consider reversal of these agents. Finally, consideration of the role of other agents such as antifibrinolytic agents in the management of the bleeding patient is important. It is important for every hospital to have a well-defined massive transfusion protocol to streamline the care of postpartum hemorrhage.Target AudienceObstetricians and gynecologists, family physicians.Learning ObjectivesAfter completing this activity, the learner should be better able to have a systematic approach to massive transfusions in postpartum hemorrhage, describe recent clinical trials on more aggressive use of plasma and tranexamic acid, and effectively monitor coagulation and for complications of massive transfusion.

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