Recommendations for managing maternal hemorrhage.(Obstetrics)

The New York State Department of Health and ACOG District II continue to support their joint recommendations for preventing maternal deaths by improving management of hemorrhage.

Seven steps to reduce the risk of maternal death from hemorrhage include:

* Perform antepartum and postpartum assessments. Identify women at increased risk of complications during pregnancy and childbirth. Women at risk include those with a history of postpartum hemorrhage, placenta previa, grand multiparity, current macrosomia, or several cesarean births. In addition, women with a history of bleeding disorders or hematologic disease are at increased risk for hemorrhage. Uterine atony is a frequent cause of postpartum hemorrhage, and women with multiple gestation, a macrosomic fetus, or a uterine abnormality are at particular risk.

* Be aware of blood loss during pregnancy, labor, and delivery. Blood loss often is underestimated. Gradual blood loss can add up to large amounts over time. Medications such as magnesium sulfate and terbutaline can increase the risk of hemorrhage. Keep in mind that 1 cup=250 cc=1 large clot=1 unit of packed red blood cells. Use clinical judgment about the need for transfusion.

* Monitor fluids and urine output. Poor urine output may indicate poor intravascular volume as a result of blood loss. Use fluid resuscitation and transfusion to replace current blood loss and continued bleeding, regardless of the mother's apparent hemodynamic stability. By the time women of reproductive age show instability, there may already be ...