2021 Volume 67 Issue 2 Pages 140-146
Among the various coagulation-related factors, fibrinogen levels are the first to decrease below critical levels during massive hemorrhage. Therefore, in obstetric hemorrhage, the lost fibrinogen should be replaced at an early stage to restore hemostatic blood levels. Recently, the use of fibrinogen concentrates for critical obstetric hemorrhage has been increasing in Japan, and its efficacy in Japanese patients is similar to that reported in patients from other countries. According to the survey conducted by the Japanese Society of Obstetrics and Gynecology on the use of fibrinogen concentrates, a median dose of 3 g is generally administered, and if the effect is inadequate, additional doses are administered. The Japanese Clinical Practice Guide for Critical Obstetrical Hemorrhage (2017 revision) states that blood transfusion should be initiated as soon as possible and recommends the prompt administration of fresh-frozen plasma and red blood cells because obstetric hemorrhage can easily result in disseminated intravascular coagulation. Moreover, the use of fibrinogens is also recommended for severe hemorrhage cases.
Evaluation of the efficacy of fibrinogen concentrates in severe cases, such as a placebo-controlled, randomized and double blind study, cannot be carried out because it is unethical. However, since it is clear that fibrinogen concentrates have a high potential for reducing maternal mortality, there is an urgent need to expand the indications for fibrinogen concentrate administration.