Obstetric Hemorrhage Massive Transfusion

Postpartum hemorrhage is excessive bleeding after birth that requires rapid recognition and treatment before shock becomes obvious. Current objective criteria support starting first-response treatment when measured blood loss is ≥300 mL with any abnormal hemodynamic sign—pulse >100 bpm, shock index >1, systolic blood pressure <100 mmHg, or diastolic blood pressure <60 mmHg—or when measured blood loss is ≥500 mL, whichever occurs first within 24 hours after birth. Maintain particular vigilance during the first 2 hours. Clinical judgement still matters: rapid ongoing bleeding or impaired perfusion warrants an immediate response even while measurement is incomplete. Activate the obstetric hemorrhage response and notify the obstetric, anesthesia, nursing, and transfusion-medicine team immediately when these criteria or clinical instability are present. Organize the causes as the four T’s. Tone is uterine atony: a poorly contracted uterus does not compress vessels at the placental bed. Trauma includes genital-tract laceration, uterine rupture, and surgical bleeding. Tissue includes retained placenta or abnormal placental attachment. Thrombin means impaired clot formation from consumption, dilution, or another coagulopathy. More than one cause may coexist. This mechanism guides action. A soft...