[Modalities for maternal transfer in the event of postpartum hemorrhage]

In the event of a postpartum bleeding, the decision to undertake a medical transfer should be made in concertation by the different physicians involved: the hospital that requests the transfer, the Emergency Medical and Mobile Service, the receiver. The choice of a health care provider depends on the health care facilities, the possibility to admit the patient and the time parameter. A transfer is contraindicated for patients with an unstable hemodynamic state and when hemostatic surgery is essential. During transportation, only cardiopulmonary techniques are allowed. Patient monitoring, anesthesia and resuscitation during the embolization process should be done by the critical care team in the hospital and not by emergency physicians and nurses. As a precaution, after the team has assessed the situation locally and before it worsens, a transfer, including intra uterine transfer, should be discussed and completed toward a health care facility equipped to provide rapid and varied emergency care. When postpartum bleeding occurs after an unexpected birth out of the hospital, rapid medical transportation toward a health care facility equipped to provide varied emergency care is required. The emergency care unit should be informed prior to the transfer.