Fibrinogen (Liminal BioSciences)

Postpartum hemorrhage is the leading cause of maternal mortality worldwide and is often complicated by hypofibrinogenemia, increasing the risk of severe hemorrhage. Fibrinogen concentrate may offer several advantages over cryoprecipitate for rapid fibrinogen replacement, but data on its availability and use in obstetric units are limited.

An IRB-approved electronic survey was distributed to all 70 Society for Obstetric Anesthesia and Perinatology (SOAP) Centers of Excellence (COE) in the United States and Canada. Responses were collected over six weeks, with three reminders.

Twenty-eight centers (40%) responded. Annual delivery volumes ranged from <2,500 (14%) to >6,000 (26%). Fibrinogen concentrate was available in 75% of the centers, but only 17 (61%) had it on the Labor and Delivery Unit. Delivery volume did not correlate with institutional (ρ = -0.11, P = 0.56) or Labor and Delivery Unit (ρ = 0.03, P = 0.89) availability of fibrinogen concentrate. In centers with availability on the Labor and delivery Unit, 94% incorporated it in their obstetric hemorrhage protocols. Preparation was most often performed by the anesthesia care team (82%), with 76% achieving readiness within 10 min. Barriers to its use included cost and unfamiliarity with reconstitution.

Although three-quarters of the SOAP COE responding institutions reported availability of fibrinogen concentrate, only 61% had it on the Labor and Delivery Unit. Availability of fibrinogen concentrate allows for a more rapid management of hypofibrinogenemia compared to cryoprecipitate in the setting of postpartum hemorrhage. Despite evidence of its effectiveness, inconsistent societal recommendations, dosing variability and educational gaps remain, highlighting the need for wider availability, greater awareness and training of personnel in its use in obstetrics.

To evaluate the effectiveness of therapeutic interventions for amniotic fluid embolism (AFE) through a systematic review and meta‐analysis, focusing on survival outcomes.

PubMed, Embase, and the Cochrane Library were searched until June 2025 for eligible studies that evaluated therapeutic interventions for AFE. The quality of the evidence was assessed using the GRADE approach. A subgroup analysis was conducted to review all potentially effective interventions reported in case reports and case series.

Two case–control studies comprising 272 patients with AFE met the inclusion criteria of this review. Platelet transfusion (adjusted Odds Ratio [OR] 0.23, 95% Confidence Interval [CI] 0.10–0.52) and fibrinogen administration (adjusted OR 0.44, 95% CI 0.21–0.92) were significantly more common among survivors, whereas hysterectomy, uterine artery embolization, red blood cell transfusion, fresh frozen plasma administration, Factor VIIa, and tranexamic acid showed no significant association with survival. The subgroup analysis identified interventions targeting circulatory support, inflammation control, coagulation management, and bleeding control.

This systematic review suggests that platelet transfusion and fibrinogen administration may improve the survival of patients with AFE. Further research is required to develop individualized treatment strategies for this rare but potentially fatal obstetric emergency.