Fibrinogen concentrate in the management of postpartum hemorrhage: a narrative review

Postpartum hemorrhage remains an important cause of mortality and morbidity, representing 27.1% of maternal deaths. Primary coagulopathy and dilutional coagulopathy occur regularly and require aggressive treatment. Tranexamic acid is identified as essential in the management of obstetric hemorrhage. The crucial role of fibrinogen is established as well. Although definite proof of the efficacy is lacking, fibrinogen concentrate is widely used to treat postpartum hemorrhage and peripartum coagulopathy. The goal of this narrative review is to summarize the existing literature regarding the use of fibrinogen during postpartum hemorrhage. We will also discuss the role of point of care testing during peripartum hemorrhage for both diagnosis and guidance of coagulation therapy. Finally, we will evaluate the role of fibrinogen administered as a concentrate or as free fresh plasma.