The only way to ensure the successful implementation of the red code is by organizing and training the staff involved with the obstetric patient care. There is still a long way to go before Bogotá implements the red code in 100 % of its II, III and IV level health institutions. 1. Centers for Disease Control and Prevention. Healthier mothers and babies. MMWR Morb Mortal Wkly Rep. 1999;48:849-58. 2. World Health Organization. Maternal Mortality in 2000. Estimates developed by WHO, UNICEF, and UNFPA. Geneva: Department of Reproductive Health and Research, World Health Organization; 2004. 3. Kane TT, El-Kady AA, Saleh S, Hage M, Stunback J, Potter L. Maternal Mortality in Giza, Egypt: magnitude, causes and prevention. Stud Fam Plann. 1992;23:45-57. 4. Prendiville WJ, Elbourne D, Mc Donald S. Active versus expectant management in the third stage of labour Cochrane review. In The Cochrane Library, Issue 3, 2003. Oxford Update Software 5. Berg CJ, Harper MA, Atkinson SM, Atkinson SM, Bell EA, Brown HL, et al. Preventability of pregnancy related deaths. Results of a state-wide review. Obstet Gynecol. 2005;106:1228-34. 6. Pritchard JA, Baldwin RM, Dickey JC, Wiggins KR, Reed GP, Bruce DM. Blood volume changes in pregnancy and the puerperium. Am J Obstet Gynecol. 1962;84:1271-82. 7. Tsen LC. Anesthesia for cesarean delivery. In: Chesnut DH, editor. Obstetric Anesthesia principles and practice. Fourth edition. Elsevier; USA; 2009. Ch 26 p. 559. 8. Tsu VD, Langer A, Aldrich T. Postpartum haemorrhage in developing countries: Is the public health community using the right tools? Int J Gynecol Obstet. 2004;85Suppl.1:s42-51. 9. World Health Organization. Manejo de las complicaciones del embarazo y del parto: guía para médicos y obstetras. WHO/RHR/.7. Washington, D.C.; OPS; 2002. 10. Duthie SJ, Ven D, Yung GL, Guang DZ, Chan SY, Ma HK. Discrepancy between laboratory determination and visual estimation of blood loss during normal delivery. Eur J Obstet Gynecol Reprod Biol. 1991;38:119-24. 11. Larsson C, Saltvedt S, Wiklund I, Pahlen S, Andolf E. Estimation of blood loss after cesarean section and vaginal delivery has low validity with a tendency to exaggeration. Acta Obstet Gynecol Scand. 2006;85:1448-52. 12. Maslovitz S, Barkai G, Lessing JB, Ziv A, Many A. Improved accuracy of postpartum blood loss estimation as assessed by simulation. Acta Obstet Gynecol Scand. 2008;87:929-34. 13. Gallos G, Redai I, Smiley RM . Role of the anesthesiologist in obstetric hemorrhage. Sem Perinatol. 2009;33:116-23. 15. Vercauteren M, Palit S, Soetens F, Jacquemyn Y, Alahuhta S. Anaesthesiological considerations on tocolytic and uterotonic therapy in obstetrics. Acta Anaesthesiol Scand. 2009;53:701-9. 16. Balki M, Ronayne M, Davies S, Fallah S, Kingdom J, Windrim R, et al. Minimum oxytocin dose requirement after cesarean delivery for labor arrest. Obstet Gynecol. 2006;107:45-50. 17. de Souza A, Permezel M, Anderson M, Ross A, McMillan J, Walker S. Antenatal erythropoietin and intra-operative cell salvage in a Jehovah´s witness with placenta praevia. Br J Obstet Gynaecol. 2003;110:524- 6. 18. Carvalho JC, Balki M, Kingdom J, Windrim R. Oxytocin requirements at elective cesarean delivery: A dose-finding study. Obstet Gynecol. 2004;104:1005-10. a. 40 U of oxytocin in 500 ml of lactate at 125 ml per hour; misoprostol 4 to 6 intrarectal tablets and 0,2 mg of IM methylergonovine b. 40 U of oxytocin in 500 ml of lactate at 125 ml per hour; misoprostol 4 to 6 intrarectal tablet and 0,1 mg of IM methylergonovine c. 40 U of oxytocine in 500 ml of lactate at 125 ml per hour; misoprostol 2 intrarectal tablets and 0,1 mg of IM methyilergonovine d. 40 U of oxytocine in 500 ml of lactate at 125 ml per hour; misoprostol 2 intrarectal tablets and 0,2 mg of IM methylergonovine 7. If the uterine bleeding persists, the patient must be taken to the OR for surgical control of hemorrhage. The following are the options to consider,with the exception of:
La única manera de garantizar el éxito de esta medida es mediante la conformación y capacitación de todo el personal involucrado en la atención de la paciente obstétrica; es decir, falta un largo camino por recorrer para que en Bogotá haya códigos rojos funcionando al ciento por ciento en todas las instituciones de II, III y IV niveles de salud.