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The implementation of a standardized massive transfusion protocol for the labor and delivery department at our institution after a maternal death caused by amniotic fluid embolism is described. This guideline was modeled on a existing protocol used by the trauma service mandating emergency release of 6\u2003units of group\u2003O D\u2013 red cells (RBCs), 4\u2003units of fresh frozen or liquid plasma, and 1 apheresis unit of platelets (PLTs). The 6:4:1 fixed ratio of uncrossmatched RBCs, plasma, and PLTs allows the transfusion service to quickly provide blood products during the acute phase of resuscitation and allows the clinical team to anticipate and prevent dilutional coagulopathy. The successful management of three cases of massive primary postpartum hemorrhage after the implementation of our new massive transfusion protocol in the maternal and fetal medicine service is described.<\/jats:p>","DOI":"10.1111\/j.1537-2995.2007.01404.x","type":"journal-article","created":{"date-parts":[[2007,8,21]],"date-time":"2007-08-21T04:52:24Z","timestamp":1187671944000},"page":"1564-1572","source":"Crossref","is-referenced-by-count":115,"title":["How we treat: management of life\u2010threatening primary postpartum hemorrhage with a standardized massive transfusion protocol"],"prefix":"10.1111","volume":"47","author":[{"given":"Matthew","family":"Burtelow","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ed","family":"Riley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurice","family":"Druzin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magali","family":"Fontaine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurene","family":"Viele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence Tim","family":"Goodnough","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2007,8,20]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00001703-200112000-00008"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1053\/sper.2003.50006"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1160\/TH05-11-0753"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0887-7963(03)00022-1"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.ta.0000199549.80731.e6"},{"key":"e_1_2_10_7_2","volume-title":"Resources for optimal care of the injured patient 2006.","year":"2006"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0300-9572(99)00140-9"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X9502300618"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006254-199006000-00003"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-005-0009-3"},{"key":"e_1_2_10_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldg016"},{"key":"e_1_2_10_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.12.074"},{"key":"e_1_2_10_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2006.06.013"},{"key":"e_1_2_10_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1423-0410.2005.00678.x"},{"key":"e_1_2_10_16_2","first-page":"470","article-title":"A mathematical model for fresh frozen plasma transfusion strategies during major trauma resuscitation with ongoing hemorrhage","volume":"48","author":"Ho AM","year":"2005","journal-title":"Can J Surg"},{"key":"e_1_2_10_17_2","first-page":"1025","article-title":"Preventing postpartum hemorrhage. managing the third stage of labor","volume":"73","author":"Maughan KL","year":"2006","journal-title":"Am Fam Phys"},{"key":"e_1_2_10_18_2","doi-asserted-by":"publisher","DOI":"10.1080\/0144361021000003555"},{"key":"e_1_2_10_19_2","unstructured":"TriulziDJ.Plasma alternatives. 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