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AACN Adv Crit Care. 2018 Fall;29(3):284-294. doi: 10.4037/aacnacc2018966.

Evidence-Based Strategies for Maternal Stabilization and Rescue in Obstetric Hemorrhage.

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Carol J. Harvey is Clinical Specialist, Women's Services and Patient Care Administration, Northside Hospital, 1000 Johnson Ferry Rd, Atlanta, GA 30342 (


Obstetric hemorrhage is one of the most frequent causes of maternal death in the United States. More than 70% of maternal deaths from hemorrhage are preventable. State and professional quality care organizations have reduced severe maternal morbidity by more than 20% by implementing evidence-based guidelines. Successful hemorrhage management requires collaborative, multidisciplinary teams of trained health care personnel. Hemorrhage management's primary goal is to stop the bleeding before the occurrence of maternal hypovolemia, acidosis, coagulopathy, and death. Uterine atony is the primary cause of obstetric hemorrhage and can be managed with uterotonic agents, placement of noninvasive uterine tamponade balloons, and surgical procedures if needed. Women experiencing massive hemorrhage should be treated according to resuscitation care guidelines with avoidance of hypothermia, acidosis, and coagulopathy. Use of a massive transfusion protocol is warranted for best outcomes. Resources for institutional adoption of current collaborative standards for managing obstetric hemorrhage are identified in this article.


critical care; hemorrhage; obstetrics; uterine hemorrhage

[Indexed for MEDLINE]

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