Early and Systematic Administration of Fibrinogen Concentrate in Postpartum Hemorrhage Following Vaginal Delivery: The FIDEL Randomized Controlled Trial. Issue 3 (24th September 2022) - Ducloy-Bouthors, A.S.
Abstract : ( BJOG . 2021;128:1814–1823) Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. Plasma fibrinogen is the first coagulation factor to drop steeply during PPH. As fibrinogen concentration decreases, risk of severe PPH increases. When fibrinogen concentrations drop below 2 g/L, there is a 100% positive predictive value for severe PPH and fibrinogen replacement is recommended. However, systematic fibrinogen administration at an earlier time, specifically, before plasma level determination, may be more effective in avoiding the progression to severe PPH. This study aimed to determine whether early and systematic administration of 3 g fibrinogen concentrate could limit postpartum hemoglobin decrease by 4 g/dL and/or limit transfusion of packed red blood cells to fewer than 2 units.