Overview of the initial urgent management of a pregnant patient with traumatic shock

IV: intravenous; SaO₂: oxygen saturation.
* For trauma patients with severe, ongoing hemorrhage that is unlikely to be controlled quickly or adequately, we suggest immediate transfusion of blood products in a 1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets. Whole blood is a reasonable alternative if available. The hospital's massive transfusion protocol should be activated immediately in such circumstances. Transfusion targets are similar to those in nonpregnant individuals, except a fibrinogen level >200 mg/dL in actively bleeding patients is desirable because pregnant people have higher baseline fibrinogen levels. A fibrinogen level >200 mg/dL in a pregnant patient is considered the minimum level necessary for adequate coagulation. Tranexamic acid 1 gram IV over 10 minutes can be given to trauma patients with signs of significant hemorrhage who present within 3 hours of injury. Some experts suggest using thromboelastogram or rotational thromboelastrometry to guide repeat dosing.