A case report of massive obstetric haemorrhage due to placental abruption describes the successful management of haemorrhage associated with a low fibrinogen level with blood products that included fibrinogen concentrate.
Fibrinogen concentrate can be available more quickly than other clotting products as it is rapidly solubilised from an ampoule in 50 ml water and given as a bolus. To raise the plasma fibrinogen concentration by 1 g/l in a 70-kg person, 1000 ml fresh frozen plasma (6 standard UK units), or 260 ml cryoprecipitate (10 standard UK units) will be required. Administration of adequate doses of fresh frozen plasma or cryoprecipitate to treat hypofibrinogenaemia during obstetric haemorrhage will therefore take a substantial amount of time, even with an efficient blood bank and portering system.
Fibrinogen concentrate use during major obstetric haemorrhage
A previous retrospective study showed its use in a series of surgical and obstetric haemorrhage cases may have been associated with a subsequent decreased need for other blood products.
Fibrinogen concentrate substitution therapy in patients with massive haemorrhage and low plasma fibrinogen concentrations
Br. J. Anaesth. (2008) 101 (6): 769-773 (Full text)