Fibrinogen for the management of critical obstetric hemorrhage

The Journal of Obstetrics and Gynaecology Research
Shigetaka MatsunagaHiroyuki Seki

Abstract

In cases of critical obstetric hemorrhage leading to extreme hypofibrinogenemia, fibrinogen is the marker that indicates the critical severity, and early fibrinogen supplementation centering on hemostatic resuscitation is a vital treatment to stabilize a catastrophic condition. In this review, we investigated the effect of fibrinogen level on hemostasis and what we can do to treat hypofibrinogenemia efficiently and improve patients' outcome. We reviewed numerous articles related to hypofibrinogenemia in critical obstetric hemorrhage. Especially, we performed a systematic review on target value of fibrinogen for hemostasis and effectiveness of fibrinogen concentrate. We also reviewed the articles about the methods for early normalization of fibrinogen level such as tranexamic acid, massive transfusion protocol, and point-of-care testing. The target value of fibrinogen calculated by needs for massive transfusion was 200 mg/dL or 10 mm of A5FIBTEM . Although fibrinogen concentrate worked poorly on fibrinogen levels within the normal range, it improved the blood fibrinogen levels rapidly when it was administered to critical obstetric hemorrhage patients with serious hypofibrinogenemia. Hence, the volume of FFP transfused could be r...Continue Reading

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Citations

Feb 18, 2020·British Journal of Haematology·Masa LasicaUNKNOWN members of the Australian and New Zealand Massive Transfusion Registry Steering Committee
Jan 4, 2021·Journal of Gynecology Obstetrics and Human Reproduction·Paulina Cecula
Dec 21, 2020·British Journal of Anaesthesia·Danny EpsteinAsaf Miller

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