Early cryoprecipitate transfusion through goal‐directed bleeding management in a real world setting—How important it is to focus on the fibrinogen in major obstetric Haemorrhage

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BACKGROUND: Postpartum haemorrhage (PPH) causes ~70 000 maternal deaths annually, making it one of the leading causes of preventable maternal mortality. This study evaluated the effectiveness of individualised goal-directed bleeding management (GDBM) in severe PPH in our centre with unique geographical challenges. METHODS: We conducted a retrospective analysis of severe PPH requiring massive transfusion over 1 years. Patients were classified into a fixed ratio (1:1:1) massive transfusion protocol (Group 1) and GDBM (Group 2). Study outcomes included blood utilisation, persistence of coagulopathy after resuscitation and mortality. The target was to keep a fibrinogen level of >200 mg/dL during the resuscitation. Thromboelastography was used to guide GDBM, and data were analysed using mean, median, percentage changes, chi-square test, student t test, and Mann-Whitney U-test. RESULTS: Out of 96 patients (42 were in Group 1 and 54 in Group 2), GDBM led to increased cryoprecipitate utilisation (410 vs. 297 units) and a higher post-resuscitation fibrinogen value (252 [185.32-426.42] mg/dL vs. 204.6 [154.5-274.05] mg/dL, p = 0.02). The cryoprecipitate turnaround time was improved (41 vs. 73 min, p < 0.001) with GDBM ensuring timely administration. Increased fibrinolysis activity was observed in 24% of the patients in TEG. The persistence of coagulopathy after deactivation of MTP was lower in GDBM (7.4% vs. 26.19%). Out of the three patients who did not survive, two were in Group 1. CONCLUSION: Individualised GDBM optimises blood utilisation, reduces turnaround time and improves coagulopathy in PPH and needs to be prioritised.

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