Obstetric Hemorrhage and the Triad of Death: How to Save More Lives

The term “triad of death” refers to the simultaneous presence of coagulopathy, acidemia, and hypothermia caused by major trauma — including obstetric hemorrhage. As the term implies, presence of this triad raises risk for severe morbidity and death. In a retrospective cohort study, investigators at one urban hospital evaluated the impact of a sustained effort throughout 15 years (2000–2014) to systematically improve the care of women with obstetric hemorrhage. Institutional changes included deployment of a massive transfusion protocol, on-call specialists in maternal fetal medicine, gynecologic oncology, and trauma surgery, daily education about important issues in managing obstetric hemorrhage, enhanced efforts to identify women at risk fo…