Treatment of Obstetric Hemorrhage with Fibrinogen Concentrate

Abstract

BackgroundPostpartum hemorrhage (PPH) is related to several factors but is frequently associated with coagulopathy with maternal mortality. Fibrinogen is a very important agent for bleeding. When its concentration is decreased, severe surgical blood loss may occur. Here, we investigate the association of postpartum bleeding characteristics with evolution of PPH in patients who were taking fibrinogen concentrate (FC).Material/MethodsPPH patients’ demographic parameters, outcome variables, and laboratory findings before and at ICU were recorded between January 2015 and July 2017. The duration of ICU stay and plasmapheresis, renal replacement therapy, maternal-fetal deaths, RBC, FFP, and PC replacement were calculated.ResultsGroup I: Fibrinogen levels were ≤150 mg/dl (n: 31), Group II: Fibrinogen levels were >151 mg/dl (n: 18). In the peroperative period, there was no difference between the 2 groups in terms of RBC, FFP, or PC transfussion. In intraoperative and ICU admission period, patients in Group I had higher INR, APTT, and PT values than in the other group. FC replacement according to fibrinogen level was given, ranging from to 1 to 6 gr in Group I and 1–2 gr in Group II intraoperatively and at ICU 2–8 gr FC was given in both groups. In the intraoperative and ICU admission period, blood transfusion requirements of patients after fibrinogen replacement were evaluated and there was no statistically significant difference between groups. There were no differrences between groups in duration of intensive care unit stay, hospital stay, and mechanical ventilation.ConclusionsAdequate FC therapy prevents unnecessary RBC, FFP, and PC replacement and prevents complications and volume overload.

Early and systematic administration of fibrinogen concentrate in postpartum haemorrhage following vaginal delivery: the FIDEL randomised controlled trial

“…Nonetheless, several other and older observational studies or reports from the UK, Japan and Turkey still maintain that fibrinogen supplementation is effective and beneficial. 14,[27][28][29][30][31] This is not surprising, as most patients in those studies presented very severe and advanced PPH, and much greater blood loss and much lower plasma fibrinogen concentrations (usually <1 g/l) than those reported in the randomised studies. Although the patients received numerous transfusions (including fresh frozen plasma, FFP) and were not compared with adequate control groups, the studies documented safety and established the usefulness of massive doses of fibrinogen (up to 8 g) to avoid FFP transfusion and fluid overload, and for rapid correction of very low fibrinogen levels.…”

“…Thus, three major randomised and well‐conducted controlled studies, FIB‐PPH, OBS2 and FIDEL, all found that early systematic fibrinogen replacement is not beneficial in the course of severe PPH management. Nonetheless, several other and older observational studies or reports from the UK, Japan and Turkey still maintain that fibrinogen supplementation is effective and beneficial 14,27–31 . This is not surprising, as most patients in those studies presented very severe and advanced PPH, and much greater blood loss and much lower plasma fibrinogen concentrations (usually <1 g/l) than those reported in the randomised studies.…”

Anesthesia management in patients with abnormally invasive placenta: A single-center experience

“…In their study, Sahin et al [18] investigated the use of fibrinogen concentrates in obstetric hemorrhages. As a result of this study, it was observed that the use of appropriate fibrinogen reduces unnecessary blood product use, thus reducing the risk of volume overload and related complications.…”

Early and Systematic Administration of Fibrinogen Concentrate in Postpartum Haemorrhage Following Vaginal Delivery: The FIDEL Randomized Controlled Trial.

“…Thus, three major randomized and well conducted controlled studies, FIB-PPH, OBS2 and FIDEL, all found that early fibrinogen replacement is not beneficial in the course of severe PPH management when a second line uterotonic agent is needed after prostaglandins and when plasma fibrinogen level is not known. Nonetheless, several other and older observational studies or reports from the UK, Japan, or Turkey still maintain that fibrinogen supplementation is effective and beneficial 14,[28][29][30][31][32] . This is not surprising, as most patients in those studies presented very severe and advanced PPH, and much greater blood loss and much lower plasma fibrinogen concentrations (usually < 1 g/L) than those reported in the randomized studies.…”