OB Hemorrhage Toolkit V 2.0

The CMQCC OB Hemorrhage Task Force developed the Improving Health Care Response to Obstetric Hemorrhage toolkit to help obstetrical providers, clinical staff, hospitals and healthcare organizations develop methods within their facilities for timely recognition and an organized, swift response to hemorrhage. The toolkit was initially released in July 2010, and was updated March 2015 to Version 2.0 with the latest evidence-based changes outlined in the Executive Summary section of the Toolkit. 
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.

The toolkit is available to download after logging into CMQCC's website. If you do not already have a CMQCC Account, you will need to complete a brief survey to initialize an account.


Improving Health Care Response to Obstetric Hemorrhage Toolkit, Version 2.0

Slide Set for Professional Education

Webinar link:  OB Hemorrhage Toolkit V2.0 Orientation Webinar


Individual sections of the toolkit are also available to download by clicking on the links below:

Executive Summary

Emergency Management Plans

Obstetric Hemorrhage Emergency Management Plan: Checklist
Obstetric Hemorrhage Emegency Management Plan: Table Chart
Obstetric Emergency Management Plan: Flow Chart Format
OB Hemorrhage Toolkit Pocket Card

Systems Level Readiness

OB Hemorrhage: Carts, Kits and Trays and Checklist

Patient Level Readiness

Placenta Accreta and Percreta: Incidence, Risk, Diagnosis, Counseling and Preparation for Delivery
Inherited Coagulation Disorders in Pregnancy
Planning for Women (Jehovah's Witnesses and Others) Who May Decline Blood and Blood Products


Definition, Early Recognition and Rapid Response Using Triggers
Risk Factor Assessment
Cumulative Quantitative Assessment of Blood Loss
Active Management of Third Stage Labor


Uterotonic Medications for Prevention and Treatment of Postpartum Hemorrhage
Blood Product Replacement: Obstetric Hemorrhage
Uterine Tamponade for Obstetric Hemorrhage: Internal Balloons and External Compression Stitches
Uterine Artery Occlusion and Embolization
Women's Experience of Obstetric Hemorrhage: Informational, Emotional and Physical Health Needs

Preparedness Considerations for Small and Rural Hospitals
Anti-Shock Garments: Non-Pneumatic Anti-Shock Garment (NASG) and Pneumatic Anti-Shock Garment (PASG)

Reporting Systems

OB Hemorrhage Measures for Hospital QI Projects


Appendix A: Stages of Hemorrhage Poster for Cart
Appendix B: Sample Scenario #2 Critical Event Team Training
Appendix C: Debriefing Tool
Appendix D: Samples of Massive Transfusion Protocols (Complete Set)
Appendix E: NHS Obstetric Early Warning Chart
Appendix F: Techniques for Quantitative Assessment of Blood Loss
Appendix G: A Guide to Recognizing Acute Stress Disorder in Postpartum Women in the Hospital Setting
Appendix H: QBL Calculator Cesarean Section
Appendix I: Two Step Quantification of Blood Loss at Cesarean Birth
Appendix J: QBL Calculator in EMR Delivery Summary