and birth. Prevention is focused on readiness, recognition and preven- DOI:10.1097/NMC.0000000000000406
active management of the third tion, multidisciplinary response, References stage of labor including intrave- and reporting and system learning American College of Obstetricians and Gyne- nous or intramuscular oxytocin, is recommended, as are hemorrhage cologists. (2017). Postpartum hemorrhage (Practice Bulletin No. 183). Obstetrics and uterine massage, and umbilical drills and team-based learning. Gynecology, 130(4), e168-e186. doi:10.1097/ cord traction (ACOG). Additional resources for PPH are AOG.0000000000002351 A number of management strate- offered by ACOG at https://www. Council on Patient Safety in Women’s Health- care. (2015). Obstetric hemorrhage (Patient gies are discussed including various acog.org/Womens-Health/Postpartum- Safety Bundle). Retrieved from http://safe medications to treat uterine atony, Hemorrhage#Providers. Nurses and healthcareforeverywoman.org/patient- transfusion of blood products, tam- other members of the obstetric clin- safety-bundles/obstetric-hemorrhage/ Lyndon, A., Lagrew, D., Shields, L., Main, E., ponade techniques, uterine artery ical team should be aware of the & Cape, V. (Eds.). (2015). Improving health embolization, and surgical manage- updated recommendations. If peri- care response to obstetric hemorrhage version 2.0. A California quality improve- ment (ACOG, 2017). A major rec- natal nurses are working on a unit ment toolkit. Stanford, CA: California ommendation is use of a standard, that does not have a PPH protocol Maternal Quality Care Collaborative and step-by-step assessment and or obstetric hemorrhage drills, Sacramento, California Department of Public Health. Retrieved from https://www. response protocol in all perinatal review and sharing of the ACOG cmqcc.org/resources-tool-kits/toolkits/ units. All care providers should practice bulletin with other mem- ob-hemorrhage-toolkit