The uterine massage does not offer benefits in the prophylaxis of PPH, but in the treatment. The current definition of active management of the third phase of delivery proposed by the World Health Organization (WHO) includes the administration of uterotonics, late cord clamping, and controlled cord traction to obtain the placenta.
Therefore, the most effective preventive measure is the active management of the third phase of delivery, which has been shown to reduce PPH by 60% of cases, a significant reduction in postpartum anemia and the need for transfusion. Uterine atony is the most common cause of PPH, since it accounts for 80% of it. The active participation of the multidisciplinary team in simulations before the protocols implementation facilitates theĀ evaluation of critical points and subsequent changes before their final application, the assessment of the adequacy of circuits and infrastructure, as well as a better protocols compliance. Massive obstetric hemorrhage has a multidisciplinary implication: obstetricians, anesthesiologists, pediatricians, midwife, nurses, auxiliary staff, and laboratory blood bank staff.
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In the red code activation protocol there are several key points to consider: the management algorithm must be known and accepted by all team members, a clear and effective communication between the team must be established and all the participants must know the role they play. Additionally, it is important to have a massive obstetric hemorrhage protocol (red code) for those patients with an important bleeding who require blood products available as soon as possible. A standard protocol must be recognized by the institution and must be accepted and known by all team members. Protocols should provide a standardized approach to evaluate and monitor the patients. In developing countries, approximately 8% of maternal death is caused by PPH. Postpartum hemorrhage (PPH) is the leading cause of maternal death.