My hospital helped develop an Massive Obstetrical Hemmorhage Protocol that has garnered recognition for our multidisciplinary team. This is an email that I sent out to my staff to help understand what is going on. There are risk levels and stage levels. A risk level is “how likely is the woman to have a hemorrhage”. Therefore, we draw and test initially based on a risk level. Low Risk = Band and Hold Medium Risk = Type and Screen High Risk = Type and Cross 2 units Stage levels coincide with “how is the patient doing” Stage 0 = Routine delivery Stage 1 = Increased bleeding but still watch and see Stage 2 = Increasing bleeding. Maternal Hemorrhage called. DIC panels every 30 minutes initiated. Products are NOT ordered at this stage. Stage 3 = Blood loss is >1500mL. DIC panels every 30 minutes. Need MOH Pack (3 RBC, 2 Plasma, 1 PLP, 1 cryo), additional packs as needed. Stage 4 = Modified post-partum care based on what stage 2 or 3 hemorrhage. Patients may go through the levels quickly but remember that the physicians are trying all options to stop the hemorrhaging. Therefore patients may never go to stage 3 but stop at stage 2. And not need any blood products. We have found over the last 3 years that they will typically transfuse everything but the cryo so we have changed the policy to not give the cryo until specifically requested (which is usually with fibrinogen <200)