Introduction of an algorithm for ROTEM ‐guided fibrinogen concentrate administration in major obstetric haemorrhage
Abstract
We compared blood component requirements during major obstetric haemorrhage, following the introduction of fibrinogen concentrate. A prospective study of transfusion requirements and patient outcomes was performed for 12 months to evaluate the major obstetric haemorrhage pathway using shock packs (Shock Pack phase). The study was repeated after the pathway was amended to include fibrinogen concentrate (Fibrinogen phase). The median (IQR [range]) number of blood components given was 8.0 (3.0-14.5 [0-32]) during the Shock Pack phase, and 3.0 (2.0-5.0 [0-26]) during the Fibrinogen phase (p = 0.0004). The median (IQR [range]) quantity of fibrinogen administered was significantly greater in the Shock Pack phase, 3.2 (0-7.1 [0-20.4]) g, than in the Fibrinogen phase, 0 (0-3.0 [0-12.4]) g, p = 0.0005. Four (9.5%) of 42 patients in the Shock Pack phase developed transfusion associated circulatory overload compared with none of 51 patients in the Fibrinogen phase (p = 0.038). Fibrinogen concentrate allows prompt correction of coagulation deficits associated with major obstetric haemorrhage, reducing the requirement for blood component therapy and the attendant risks of complications.
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In active bleeding, fibrinogen concentrates used as an adjunctive treatment of obstetrical hemorrhage may reduce the need for massive transfusion.
“In cases of active bleeding, the use of fibrinogen concentrates as an adjunctive treatment of obstetrical hemorrhage may reduce the need for massive transfusion (104, 105).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [104]
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- Authors
- Mallaiah, S., Barclay, P., Harrod, I., Chevannes, C., & Bhalla, A.
- Affiliations
- Liverpool Women's Hospital (GB)
- Corresponding author
- Mallaiah, S.
- ORCID
- Bhalla, A.
- Venue
- Anaesthesia
- Publisher
- Wiley
- Published
- 2014-10-07
- Volume
- 70
- Issue
- 2
- Pages
- 166-175
- ISSN
- 0003-2409 (ISSN-L)
- 1365-2044
- OpenAlex
- W1970331972
- Cited by
- 213
- References
- 34
- Citations by year
- 2026: 9 · 2025: 16 · 2024: 13 · 2023: 17 · 2022: 22 · 2021: 20 · 2020: 16 · 2019: 21 · 2018: 11 · 2017: 21 · 2016: 24 · 2015: 19 · 2014: 2 · 2013: 2
- FWCI
- 15.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Anaesthesia (publishedVersion)
- PubMed (publishedVersion)
- Funders
- CSL Behring
- University of Liverpool
- Topics
- Health Sciences › Medicine › Biochemistry › Blood transfusion and management
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Keywords
- major obstetric haemorrhage, fibrinogen concentrate, rotational thromboelastometry, coagulopathy, transfusion-associated circulatory overload, obstetric transfusion, coagulation therapy
- MeSH terms
- Algorithms, Blood Coagulation, Blood Transfusion, Female, Fibrinogen, Postpartum Hemorrhage, Hemostatics, Humans, Pregnancy, Prospective Studies, Thrombelastography, Treatment Outcome
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