OB Hemorrhage Toolkit Version 2.0

CMQCC announces the public release of

Improving Health Care Response to Obstetric Hemorrhage: Version 2.0

A California Quality Improvement Toolkit




The Toolkit 2.0 can be downloaded upon completion of a brief registration survey.  The Toolkit includes care guidelines (in checklist, flowchart or table chart formats) and a slide set for professional education in PDF format.

(*Please note this download does NOT work in Safari web browser, so use Firefox or Chrome).

The primary aim of the Toolkit is to guide and support maternity care providers, clinical staff, hospitals and healthcare organizations to facilitate timely recognition and an organized, swift response to postpartum hemorrhage.   Originally released in 2010, this updated Toolkit was developed by the CMQCC OB Hemorrhage 2.0 Task Force, a multidisciplinary committee of experts, co-chaired by Audrey Lyndon PhD, RNC, FAAN (University of California, San Francisco) and David Lagrew, MD (Memorial Care Health System).


Key Changes from Version 1.0

  • Modified format to improve usability
  • Added parameters for ongoing risk assessment at least at every shift or patient handoff.
  • Emphasizes oxytocin as the main component and definitively states that active management of third stage labor (AMTSL) should not interfere with delayed cord clamping
  • Continues to emphasize oxytocin as first line for prevention and treatment and offers changes in misoprostol dosing recommendations
  • Clarifications around blood replacement recommendations
  • Substantial expansion on patient and family support and a resource list
  • Additional structure, process and outcome measures

California hospitals are invited to participate in the California Partnership for Maternal Safety (CPMS), which is aligned with the National project; both aim to have a hemorrhage patient safety bundle implemented in every birthing facility. 

Public information webinars will be held April 30 and May 27, from 12:30-2:00 pm PST - Mark your calendar and check back for more details.  


Obstetric hemorrhage is a leading and extremely preventable cause of maternal mortality. The overall rate of postpartum hemorrhage in the US increased 26% between 1994 and 2006. Rapid recognition and treatment are necessary to prevent progression of hemorrhage as women can lose large volumes of blood very quickly due to the physiologic changes of pregnancy. However, obstetric hemorrhage is also a low-volume, high-risk event for any given birth facility: without advance planning the probability of mounting a rapid, coordinated response is low. Indeed, maternal mortality reviews have consistently revealed problems with recognition, communication, and effective application of interventions as contributory factors in deaths from hemorrhage, and accounted for 10% of maternal deaths in California, according to the California Pregnancy Associated Maternal Mortality Review (CA-PAMR), a project of the California Department of Public Health; Maternal, Child and Adolescent Health Division (CDPH/MCAH).