Haemostatic management of obstetric haemorrhage

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Summary: The haemostatic management of major obstetric haemorrhage remains challenging, and current published guidance relies heavily on experience from the non‐pregnant population and expert opinion. In recent years, an interest in the implications of relative hypofibrinogenaemia, point‐of‐care monitoring of coagulation abnormalities, and the potential to give goal‐directed therapy to correct coagulopathies, have created the possibility of significantly challenging and changing guidance. There is evidence that the haemostatic impairment in the pregnant population is different from trauma‐induced bleeding, and the type and rate of onset of coagulopathies differ depending on the underlying cause. This review examines areas such as possible intervention points, describes evidence for over‐transfusion of fresh frozen plasma in some situations and challenges conventional thinking on formulaic management. It also examines the rationale for other therapeutic options, including fibrinogen concentrate and tranexamic acid.

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