Crtical Care and Shock Journal

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.

Anouar Jarraya, Manel Kammoun, Karim Bouzid, Yesmine Ellouze, Kais Chaabene, Kamel Kolsi


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