Morbidity associated with fresh frozen plasma administration for postpartum hemorrhage requiring transfusion: a retrospective cohort study (2016-2024).

BACKGROUND

Recommendations for fresh frozen plasma transfusion in postpartum hemorrhage are inconsistent and empiric administration may carry more risk than benefit. We characterized fresh frozen plasma use for postpartum hemorrhage with normal international normliazed ratio (INR) and associated adverse outcomes.

METHODS

Patients with postpartum hemorrhage (quantitavie blood loss ≥1000 mL) and INR ≤1.5 who received transfusion of any blood product during their delivery admission in a large tertiary academic center between 2016 and 2024 were identified. Those who received fresh frozen plasma were compared to those who did not.

RESULTS

Among 54,041 deliveries during the study period, 3,827 (7.1%) had a diagnosis of postpartum hemorrhage of which 530 (0.98%) were transfused. Among these, 489/530 (92%) had an INR ≤1.5, yet 37% received fresh frozen plasma. First fresh frozen plasma was frequently transfused prior to INR availability (62.8%). After adjusting for significant covariates, patients transfused with fresh frozen plasma had higher odds of composite adverse outcomes, admission to intensive care unit, and prolonged length of stay.

CONCLUSION

Despite coagulopathy being uncommon during postpartum hemorrhage, fresh frozen plasma is often administered empirically in patients with normal INR and is associated with increased risk of adverse outcomes.