An update on the use of massive transfusion protocols in obstetrics

Am J Obstet Gynecol. 2016 Mar;214(3):340-4. doi: 10.1016/j.ajog.2015.08.068. Epub 2015 Sep 5.


Obstetrical hemorrhage remains a leading cause of maternal mortality worldwide. New concepts involving the pathophysiology of hemorrhage have been described and include early activation of both the protein C and fibrinolytic pathways. New strategies in hemorrhage treatment include the use of hemostatic resuscitation, although the optimal ratio to administer the various blood products is still unknown. Massive transfusion protocols involve the early utilization of blood products and limit the traditional approach of early massive crystalloid-based resuscitation. The evidence behind hemostatic resuscitation has changed in the last few years, and debate is ongoing regarding optimal transfusion strategies. The use of tranexamic acid, fibrinogen concentrates, and prothrombin complex concentrates has emerged as new potential alternative treatment strategies with improved safety profiles.

Keywords: hemostatic resuscitation; massive transfusion; obstetrical hemorrhage.

Publication types

  • Review

MeSH terms

  • Blood Transfusion / methods*
  • Blood Transfusion / standards
  • Clinical Protocols
  • Combined Modality Therapy
  • Female
  • Fluid Therapy / methods
  • Fluid Therapy / standards
  • Hemostatics / therapeutic use
  • Humans
  • Postpartum Hemorrhage / therapy*
  • Pregnancy
  • Resuscitation / methods
  • Resuscitation / standards
  • Transfusion Reaction


  • Hemostatics