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.

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.