Viscoelastometry guided fresh frozen plasma infusion for postpartum haemorrhage: OBS2, an observational study

Background Postpartum haemorrhage (PPH) may be exacerbated by haemostatic failure. Based on data from trauma studies, empirical infusions of fresh frozen plasma (FFP) are often given during severe PPH if coagulation tests are unavailable. This study observed a cohort of women with moderate/severe PPH in whom FFP infusion was guided by the use of viscoelastometric point-of-care testing (VEPOCT) and clinical assessment. Methods Women were enrolled into this observational study when blood loss was measured or suspected to be about 1000 mL. If Fibtem A5 remained >15 mm, or bleeding stopped, FFP was withheld. If Fibtem A5 was ≤15 mm and bleeding ongoing women were randomised into an interventional study as previously reported. Clinical and laboratory outcomes were recorded. Results The study recruited 605 women and 98% had FFP withheld. The median (25th-75th centile) total blood loss was 1500 (1300-2000) mL with 300 (50-545) mL occurring after enrolment. Total blood loss was >2500 mL in 40/605 (6.6%) women. RBCs were transfused in 141/605 (23.3%) cases and 11 (1.8%) received ≥4 units. At least one invasive procedure was performed in 283/605 (46.8%) women. Level 3 care was required for 10/605 (1.7%) women. No women developed clinically significant haemostatic impairment. Conclusions A restrictive use of FFP guided by clinical assessment of bleeding and VE-POCT is feasible and did not result in clinically significant haemostatic impairment. Studies should compare the clinical and cost effectiveness of empirical FFP infusions, according to current guidelines, with a targeted use of FFP based on VE-POCT