Version June 2024
| Notify staff and services that will or may be needed: anesthesia, blood bank, surgery (eg, obstetrics, pelvic surgery, maternal-fetal medicine, gynecologic oncology, interventional radiology, and/or general surgery), neonatology. |
| Place at least two large bore (≥18 gauge) catheters. |
| Administer crystalloid with or without colloid, blood, and blood products, as needed. O-negative red blood cells, group AB FFP, and lyophilized fibrinogen can be given immediately and continued until the type and cross-match is complete, at which point the patient should be switched to type-specific FFP and cross-match compatible red blood cells. Try to keep hemoglobin above 7 g/dL and as high as 8 to 10 g/dL in patients with severe active bleeding, fibrinogen level above 300 mg/dL, platelet count above 50,000/microL, and PT and PTT <1.5 times control. |
| Maintain oxygen saturation above 95%. |
| Keep the patient warm. |
| Identify and begin treatment of the triggering event. |
| Order laboratory panel to assess coagulation (PT, aPTT, fibrinogen); draw 5 mL blood in a red top tube and observe clot formation over 8 to 10 minutes. |
| Order baseline laboratory panel: CBC, BUN, creatinine, liver function tests. |
| Assess fetal status (gestational age, fetal heart rate). |
| Assess maternal condition (blood loss, hemodynamic stability, uterine contractions, cervical status). |
| Appropriate personnel, equipment, and supplies (eg, pelvic pack) should be available if hysterectomy is being considered. |
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