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

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dc.authorid0000-0003-1102-9741
dc.authorid0000-0002-4870-2840
dc.authorid0000-0001-6436-4020
dc.authorid0000-0002-0199-6474
dc.contributor.authorKüçükbaş, Mehmet
dc.contributor.authorGüner Özen, Eda
dc.contributor.authorÖzen, Süleyman
dc.contributor.authorSelçuk, Selçuk
dc.contributor.authorPolat, Mesut
dc.contributor.authorKarateke, Ateş
dc.date.accessioned2025-07-11T12:45:41Z
dc.date.available2025-07-11T12:45:41Z
dc.date.issued2025
dc.departmentFakülteler, Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümü, Kadın Hastalıkları ve Doğum Ana Bilim Dalı
dc.description.abstractBackground - 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.
dc.identifier.citationKüçükbaş, 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
dc.identifier.doi10.2450/BloodTransfus.1044
dc.identifier.endpage9
dc.identifier.issn2385‑2070
dc.identifier.scopusqualityQ2
dc.identifier.startpage1
dc.identifier.urihttps://doi.org/10.2450/BloodTransfus.1044
dc.identifier.urihttps://hdl.handle.net/20.500.13055/1032
dc.identifier.wosqualityQ2
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynak.otherSCI-E - Science Citation Index Expanded
dc.institutionauthorKüçükbaş, Mehmet
dc.language.isoen
dc.publisherSIMTI
dc.relation.ispartofBlood Transfusion
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectFibrinogen Concentrate
dc.subjectPostpartum Hemorrhage
dc.subjectBlood Coagulation Disorders
dc.subjectHemostatic Agents
dc.titleEarly fibrinogen replacement based on shock index and lactate levels in massive postpartum hemorrhage: A retrospective cohort study
dc.typeArticle
dspace.entity.typePublication

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