Early fibrinogen replacement based on shock index and lactate levels in massive postpartum hemorrhage: A retrospective cohort study

Kapalı Erişim

Tarih

2025

Dergi Başlığı

Dergi ISSN

Cilt Başlığı

Yayıncı

SIMTI

Erişim Hakkı

info:eu-repo/semantics/openAccess

Araştırma projeleri

Organizasyon Birimleri

Dergi sayısı

Özet

Background - Massive postpartum hemorrhage (PPH) remains a major cause of maternal morbidity and mortality worldwide. Timely fibrinogen replacement is critical in hemostatic resuscitation, yet laboratory delays may hinder early intervention. This study evaluates the clinical outcomes of early fibrinogen concentrate administration in massive PPH using a protocol based on shock index and serum lactate levels rather than laboratory-confirmed hypofibrinogenemia. Materials and methods - This retrospective cohort study included 103 PPH patients treated at a tertiary hospital in Istanbul, Turkey, between 2016 and 2020. Patients were divided into four groups based on fibrinogen dose: Group I (<2 g), Group II (2–4 g), Group III (>4 g), and Group IV (non-massive PPH, no fibrinogen). A predefined protocol guided early fibrinogen administration based on clinical indicators. Fibrinogen was administered without awaiting lab confirmation. Results - Group III had the highest estimated blood loss (2,600±500 mL) and Group IV the lowest (600±150 mL; p<0.001). ICU admission was significantly lower in Group III (23.8%) than in Group I (62.1%; p=0.020). Group III patients also had fewer secondary surgical interventions and reduced transfusion requirements compared to Groups I and II. No thromboembolic events or mortality were observed in any group. Discussion - Early fibrinogen replacement based on shock index and lactate levels appears feasible and beneficial in managing massive PPH. This approach was associated with improved hemostatic control, reduced ICU admissions, and fewer surgical interventions. Prospective studies are warranted to further assess this strategy’s safety, efficacy, and cost-effectiveness.

Açıklama

Anahtar Kelimeler

Fibrinogen Concentrate, Postpartum Hemorrhage, Blood Coagulation Disorders, Hemostatic Agents

Kaynak

Blood Transfusion

WoS Q Değeri

Q2

Scopus Q Değeri

Q2

Cilt

Sayı

Künye

Küçükbaş, M., Güner Özen, E., Özen, S., Selçuk, S., Polat, M., & Karateke, A. (2025). Early fibrinogen replacement based on shock index and lactate levels in massive postpartum hemorrhage: A retrospective cohort study. Blood Transfusion, pp. 1-9. https://doi.org/10.2450/BloodTransfus.1044