An aggressive coordinated multidisciplinary approach between obstetricians, midwives, anesthesiologists, the labora tory, and blood bank is required (Figure 1 ). Initial management depends on the cause of the hemorrhage and whether delivery of the fetus has occurred. Where the hemorrhage occurs postpartum, uterine atony with or without retained products should be suspected. Oxytocin should be administered, the bladder should be emptied, and the uterus massaged. Intravenous access is obtained, blood is sent for crossmatching, and if crossmatched blood is unavailable, O negative blood is obtained. Th e obstetrician should examine the genital tract for evidence of trauma. If bleeding persists, prostaglandin therapy -either intravenous prostaglandin E 2 or 15-methyl prostaglandin F 2α -is administered. Consideration should be given to uterine tamponade, by packing or balloon compression. Continued bleeding should result in surgical intervention: arterial ligation, B-Lynch suture, Cesarean hyste rectomy, or uterine artery embolization [4] . It is important that these interventions occur without delay; with each advancing minute, continued blood loss leads to loss of clotting factors, coagulopathy, and the potential for exsanguination. It is imperative that the patient be kept warm and that blood products and fl uids be warmed through a rapid transfusion device. An arterial line should be placed to measure blood pressure and pulse pressure variability and to take blood samples to track hematocrit and acid-base status. Ideally, quali tative tests of clot quality (for example, thrombo elastography) would be combined with coagulation studies to guide blood component resuscitation. In the event of uncontrolled non-surgical bleeding, consideration should be given to the administration of recombinant factor VIIa (90 μg/kg, repeated at 20 minutes if there is no response) [5] [6] [7] .