Approach to Massive Bleeding in Obstetrics: Changing Management Paradigms Oriented by Early Goals [Early Goal Therapy in Postpartum Hemorrhage]

Recent\r\nfindings: Approximately 830 women die every day worldwide as a result of\r\ncomplications related to pregnancy or childbirth with obstetric hemorrhage that\r\nremains a major cause of maternal morbidity and mortality. A systematic\r\nanalysis by the World Health Organization [WHO] on the global causes of\r\nmaternal deaths from 2003 to 2009 found that bleeding was the leading direct\r\ncause of maternal mortality followed by hypertensive disorders and sepsis.\r\nOverall, bleeding accounted for 27.1% of all maternal deaths worldwide. The\r\nneed to implement strategies that mitigate the impact of bleeding in this clinical\r\nscenario is increasingly growing. Purpose of review: The purpose of this review\r\nis to propose a management strategy based on goals established through dynamic\r\ncoagulation assessment. Summary: Effective management of obstetric hemorrhage\r\nrequires rapid recognition, rapid response and mobilization of the\r\nmultidisciplinary team. Volumetric resuscitation, hemodynamic stability, as\r\nwell as the simultaneous identification and treatment of the source of bleeding\r\nand the resolution of coagulopathy in the shortest possible time remain the\r\ncornerstones of the management of Postpartum Hemorrhage (PPH).