Critical Care and Shock

The impact of fresh frozen plasma versus fibrinogen concentrates on maternal outcomes in a severe postpartum hemorrhage requiring massive transfusion

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Objective: Massive transfusions after major postpartum hemorrhage can lead to severe maternal morbidity and mortality. The aim of this study was to compare the impact of early fibrinogen concentrates versus a high ratio of fresh frozen plasma over red blood cells (FFP/RBC) on maternal outcomes.

Design: This was a retrospective study.

Setting: The study was conducted in the Hedi Chaker University Hospital, University of Sfax, Tunisia from January 2019 to January 2022.

Patients and participants: In this study, we included all patients requiring a massive transfusion after severe postpartum hemorrhage. We also excluded patients with incomplete data or who did not adhere to the protocol of the study. Finally, 42 patients were included.

Interventions: Patients were divided into 2 groups:

Group 1: Patients who received 2 g of fibrinogen concentrates followed by a ratio of FFP/RBC of 1.

Group 2: Patients who received a ratio of FFP/RBC of 2 without fibrinogen concentrates administration.

Then, we compared maternal outcomes and transfusion-related adverse events in both groups.

Measurements and results: Demographic and preoperative parameters were comparable. The blood loss was 4731 and 4576 ml in Group 1 and Group 2, respectively (p=0.604). The need for platelets transfusion was lower in Group 2 (p=0.001) as well as the incidence of transfusion-related acute lung injury (TRALI) (p=0.039) and renal failure (p=0.044). A high ratio of FFP/RBC reduced the length of stay in intensive care units from 5.58±2.1 to 3.07±1.6 days (p=0.002). The need for catecholamine infusion more than 24 hours after massive transfusion was seen in 17 patients in Group 1 versus 8 patients in Group 2 (p=0.038). Mortality rates were comparable in both groups.

Conclusions: A 2:1 ratio of FFP/RBC without fibrinogen concentrates transfusion seems to be beneficial in massive transfusion in postpartum hemorrhage. However, further high-quality, adequately powered studies are needed to assess the impact of this ratio and the role of fibrinogen concentrates on maternal outcomes.