Early Viscoelastometric Guided Fibrinogen Replacement Combined With Escalation of Clinical Care Reduces Progression in Postpartum Hemorrhage: A Comparison of Outcomes From Two Prospective Observational Studies

( Int J Obstet Anesth . 2024:59:104209. doi: 10.1016/j.ijoa.2024.104209) Coagulation of blood during postpartum hemorrhage (PPH) typically remains unchanged, however when it fails, the risk of progression to severe PPH is high. Coagulopathy can be difficult to identify and may go either untreated or inadequately treated, contributing to a high mortality rate among those with severe PPH. Known risk factors for coagulopathy include severe abruption, fetal demise, and amniotic fluid embolism, among others. Methods researched to stop the progression of PPH in patients with coagulopathy have included early empirical use of fibrinogen concentrate and viscoelastometric hemostatic assay (VHA)-guided resuscitation. However, studies have shown neither approach to be effective, although data with sufficient power to detect effects in the study population is lacking. This study was designed to compare outcomes in patients with PPH before and after integrating VHA-guided fibrinogen replacement during treatment.