O&G Cases · Critical care in obstetrics and gynaecology
Running the massive obstetric haemorrhage protocol — emergency management station
Team-based emergency station: running an obstetric massive haemorrhage protocol in a woman with a contracted uterus and ongoing bleeding. Tests protocol activation with named roles, re-examination for genital tract trauma as the leading cause of massive PPH, goal-directed replacement from fed viscoelastic and biochemistry results, calcium and temperature management, the surgical decision point, deliberate de-activation, and structured handover. Includes assessor timeline, marking domains, assessor key and fail criteria.
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Station brief
Format. Emergency management station, approximately 12 minutes, with 4 minutes reading. You are the obstetric registrar. The assessor runs the clock, plays the blood bank and the laboratory, and feeds new observations and results. [1]
Candidate instruction. Lead the resuscitation and transfusion management of this massive obstetric haemorrhage. Verbalise your actions, your product and drug orders with targets, your escalation triggers, and your communication with the team, the blood bank, the consultant and the woman. Uterotonic sequencing has already been completed — this station is about what happens next. [1][3]
References11ShowHide
- [1]Royal College of Obstetricians and Gynaecologists (RCOG) Prevention and Management of Postpartum Haemorrhage: Green-top Guideline No. 52 BJOG, 2017.PMID 27981719
- [2]Bell SF, Collis RE, Bailey C, et al. The incidence, aetiology, and coagulation management of massive postpartum haemorrhage: a two-year national prospective cohort study Int J Obstet Anesth, 2021.PMID 33994274
- [3]Bell SF, Collis RE, Pallmann P, et al. Reduction in massive postpartum haemorrhage and red blood cell transfusion during a national quality improvement project, Obstetric Bleeding Strategy for Wales, OBS Cymru: an observational study BMC Pregnancy Childbirth, 2021.PMID 33992094
- [4]Collins PW, Lilley G, Bruynseels D, et al. Fibrin-based clot formation as an early and rapid biomarker for progression of postpartum hemorrhage: a prospective study Blood, 2014.PMID 25024304
- [5]McNamara H, Kenyon C, Smith R, et al. Four years' experience of a ROTEM-guided algorithm for treatment of coagulopathy in obstetric haemorrhage Anaesthesia, 2019.PMID 30950521
- [6]Ho KM, Leonard AD Concentration-dependent effect of hypocalcaemia on mortality of patients with critical bleeding requiring massive transfusion: a cohort study Anaesth Intensive Care, 2011.PMID 21375089
- [7]Kander T, Schött U Effect of hypothermia on haemostasis and bleeding risk: a narrative review J Int Med Res, 2019.PMID 31475619
- [8]WOMAN Trial Collaborators Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial Lancet, 2017.PMID 28456509
- [9]Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial JAMA, 2015.PMID 25647203
- [10]Karaca Z, Kelestimur F Sheehan syndrome: a current approach to a dormant disease Pituitary, 2025.PMID 39863703
- [11]Kontomanolis EN, Prokopakis I, Koutras A, et al. Pregnancy-Related Acute Kidney Injury: Causes and Its Impact on Perinatal Outcomes-A Systematic Review J Clin Med, 2025.PMID 40943787