Point-of-Care Fibrinogen Testing and Hemorrhage Outcomes in Severe Postpartum Hemorrhage: An Interrupted Time Series...

Increasingly, point-of-care testing has been adopted to rapidly assess fibrinogen levels for managing severe postpartum hemorrhage; however, evidence regarding its impact on clinical outcomes is limited. We evaluated whether implementing a transfusion strategy guided by point-of-care testing was associated with changes in blood loss and transfusion outcomes in patients with severe postpartum hemorrhage.

We conducted a retrospective single-center interrupted time series analysis at a tertiary perinatal referral center in Japan. Consecutive patients with severe postpartum hemorrhage (blood loss, ≥ 1000 mL) requiring emergency transfer between April 2014 and March 2019 were included. A dry hematology-based point-of-care testing system combined with a standardized transfusion protocol was introduced in March 2016. The primary outcome was total blood loss. Secondary outcomes included transfusion volumes and in-hospital maternal mortality. Segmented regression models were used to estimate changes in level and trend before and after implementation.

Among 142 patients included (52 before and 90 after intervention implementation), baseline severity indicators were higher in the pre-intervention period. Implementation of the point-of-care testing-guided transfusion strategy was not associated with significant changes in total blood loss or volumes of red blood cells or fresh frozen plasma transfused. Similar findings were observed for in-hospital outcomes. Results were consistent across the adjusted and sensitivity analyses.

Implementing a point-of-care testing-guided transfusion strategy was not associated with significant improvements in blood loss or transfusion outcomes among patients with severe postpartum hemorrhage at our tertiary referral center. These findings should be interpreted within the context of this institutional setting and do not exclude the possibility that point-of-care testing may provide clinical benefit in other patient populations or healthcare settings. Further studies are needed to identify the clinical settings in which point-of-care testing-guided transfusion strategies are most effective.