Selected Guideline Examples Date
ROTEM Protocol  October 2019
Obs Cymru PPH Checklist
October 2019
RPH Management of Massive Obstetric Haemorrhage March 2017
Lancashire Guideline
What We Liked
  • Clear pathway to escalate 
  • Estimated time taken to crossmatch blood and where to find O negative blood
  • Highlights need to avoid hypothermia and consideration of thromboprophylaxis
  • Mentions use of IOCS
What We Didn't Like
  • Resuscitation only, ie immediate management
  • Delayed administration of tranexamic acid
  • No mention of potential need for invasive monitoring 
  • No discussion of RA vs GA in MOH
Not Sure
  • 1:1 ratio of PRC:FFP; not in line with ObsCymru research
Other Comments
  • Note there were different definitions of MOH and triggers for protocols between units (1-2 litres)
  • All mention POC testing including Haemocue, TEG/ROTEM if available on their unit
  • All mention warming patient including using warm fluids and blood products
  • Should encourage use of 4:4:1 replacement in line with current evidence

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