A well-considered transfusion protocol, created by a multidisciplinary group consisting of obstetrician gynecol- ogists, obstetrical anesthesiologists, hematologists, and blood bank/laboratory medicine specialists, will offer lo- cal options. A massive transfusion protocol should be available in each hospital and known to all relevant care pro- viders. The creation of such a protocol is beyond the scope of this manuscript. It is important to remember that undiagnosed bleeding disorders can be responsible for postpartum hemorrhage, and von Willebrand disease is the most common bleeding entity discovered in this setting. A summary of available approaches to treat postpar- tum hemorrhage has been published [28], but present guidelines can be improved by providing more specific al- gorithms, including the array of presently available interventions. Thromboelastography provides point of care monitoring to assess hemostasis in postpartum hemorrhage [29]. Promising interventions include tranexamic acid and fibrinogen concentrate and both are being prospectively evaluated in clinical trials [30] [31].