Introduction of an algorithm for ROTEM-guided fibrinogen concentrate administration in major obstetric haemorrhage

Area of Science:

• Obstetrics and Gynecology
• Hematology
• Critical Care Medicine

Background:

• Major obstetric hemorrhage (MOH) is a leading cause of maternal mortality.
• Traditional management relies on massive transfusion protocols using blood components.
• Coagulation factor deficiencies, particularly fibrinogen, are critical in MOH.

Purpose of the Study:

• To compare blood component requirements and patient outcomes in MOH before and after implementing fibrinogen concentrate.
• To evaluate the effectiveness of a revised MOH management pathway incorporating fibrinogen concentrate.

Main Methods:

• Prospective study comparing two 12-month periods: 'Shock Pack phase' (standard care) and 'Fibrinogen phase' (including fibrinogen concentrate).
• Data collected on transfusion requirements (number of blood components, fibrinogen quantity) and patient outcomes (transfusion-associated circulatory overload).

Main Results:

• Significantly lower median blood component use in the Fibrinogen phase (3.0 components) vs. Shock Pack phase (8.0 components) (p=0.0004).
• Reduced median fibrinogen administration in the Fibrinogen phase (0 g) compared to the Shock Pack phase (3.2 g) (p=0.0005), indicating targeted use.
• Zero cases of transfusion-associated circulatory overload in the Fibrinogen phase versus 4 cases (9.5%) in the Shock Pack phase (p=0.038).

Conclusions:

• Fibrinogen concentrate enables rapid correction of coagulopathy in MOH.
• Its use significantly decreases the need for extensive blood component therapy.
• This approach reduces the incidence of transfusion-related complications, improving patient safety in obstetric emergencies.