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Related Experiment Video

Updated: Dec 23, 2025

Standardized Hemorrhagic Shock Induction Guided by Cerebral Oximetry and Extended Hemodynamic Monitoring in Pigs
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How do I manage severe postpartum hemorrhage?

Alexander Butwick1, Deirdre Lyell2, Lawrence Goodnough3

  • 1Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA.

Transfusion
|April 23, 2020
PubMed
Summary

Severe postpartum hemorrhage (PPH) management requires a coordinated approach. This study details a system-wide strategy for PPH, including massive transfusion protocols and advanced monitoring, to improve maternal outcomes.

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Area of Science:

  • Obstetrics and Gynecology
  • Hematology
  • Critical Care Medicine

Background:

  • Postpartum hemorrhage (PPH) is a leading cause of maternal mortality and morbidity in the US.
  • Placenta accreta spectrum disorder is a significant risk factor for life-threatening PPH.
  • Effective management of severe PPH is a national health priority.

Purpose of the Study:

  • To describe a system-wide approach for managing severe PPH, particularly in cases of placenta accreta spectrum disorder.
  • To review current evidence on transfusion strategies and hemostatic monitoring during active postpartum bleeding.
  • To outline the integration of tranexamic acid and fibrinogen concentrate into PPH treatment protocols.

Main Methods:

  • Activation and utilization of a massive transfusion protocol for timely blood product delivery.
  • Application of viscoelastic monitoring (thromboelastography) and standard laboratory tests for coagulation assessment.
  • Review of recent evidence on adjunct therapies like tranexamic acid and fibrinogen concentrate.

Main Results:

  • Implementation of a structured massive transfusion protocol ensures adequate blood product availability.
  • Viscoelastic monitoring and laboratory tests provide comprehensive assessment of the maternal coagulation profile.
  • Evidence supports the use of tranexamic acid and fibrinogen concentrate as adjuncts in PPH management.

Conclusions:

  • A systematic, multidisciplinary approach is crucial for managing severe PPH.
  • Advanced monitoring and timely transfusion are key components of effective PPH care.
  • Incorporating evidence-based adjunct therapies enhances PPH prevention and treatment strategies.