How to Manage Postpartum Hemorrhage

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Postpartum hemorrhage is defined as ≥1000mL of blood loss irrespective of the delivery route, with associated shock. Remember the four “T’s”: tone (uterine atony), trauma (lacerations, uterine rupture), tissue (retained placenta, clots) and thrombin (coagulopathies). Manage the ABCs (especially two large bore IV’s for massive transfusion) and tailor treatment to the specific cause. Recommendations for balanced transfusion are derived from the trauma literature, but it is important to administer cryoprecipitate earlier to maintain a higher fibrinogen level (at term the normal level is >350mg/dL).

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