{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T13:38:43Z","timestamp":1786714723273,"version":"build-2736575974"},"reference-count":38,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion Medicine"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postpartum haemorrhage (PPH) causes ~70\u2009000 maternal deaths annually, making it one of the leading causes of preventable maternal mortality. This study evaluated the effectiveness of individualised goal\u2010directed bleeding management (GDBM) in severe PPH in our centre with unique geographical challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective analysis of severe PPH requiring massive transfusion over 1\u2009years. Patients were classified into a fixed ratio (1:1:1) massive transfusion protocol (Group 1) and GDBM (Group 2). Study outcomes included blood utilisation, persistence of coagulopathy after resuscitation and mortality. The target was to keep a fibrinogen level of &gt;200\u2009mg\/dL during the resuscitation. Thromboelastography was used to guide GDBM, and data were analysed using mean, median, percentage changes, chi\u2010square test, student\n                      <jats:italic>t<\/jats:italic>\n                      test, and Mann\u2013Whitney\n                      <jats:italic>U<\/jats:italic>\n                      \u2010test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Out of 96 patients (42 were in Group 1 and 54 in Group 2), GDBM led to increased cryoprecipitate utilisation (410 vs. 297\u2009units) and a higher post\u2010resuscitation fibrinogen value (252 [185.32\u2013426.42] mg\/dL vs. 204.6 [154.5\u2013274.05] mg\/dL,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). The cryoprecipitate turnaround time was improved (41 vs. 73\u2009min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) with GDBM ensuring timely administration. Increased fibrinolysis activity was observed in 24% of the patients in TEG. The persistence of coagulopathy after deactivation of MTP was lower in GDBM (7.4% vs. 26.19%). Out of the three patients who did not survive, two were in Group 1.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Individualised GDBM optimises blood utilisation, reduces turnaround time and improves coagulopathy in PPH and needs to be prioritised.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tme.70072","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T15:01:46Z","timestamp":1773759706000},"page":"386-394","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early cryoprecipitate transfusion through goal\u2010directed bleeding management in a real world setting\u2014How important it is to focus on the fibrinogen in major obstetric Haemorrhage"],"prefix":"10.1111","volume":"36","author":[{"given":"Ganesh","family":"Mohan","sequence":"first","affiliation":[{"name":"Department of Immunohaematology and Blood Transfusion, Kasturba Medical College Manipal Academy of Higher Education  Manipal Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamee","family":"Shastry","sequence":"additional","affiliation":[{"name":"Department of Immunohaematology and Blood Transfusion, Kasturba Medical College Manipal Academy of Higher Education  Manipal Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prethika","family":"P. A.","sequence":"additional","affiliation":[{"name":"Department of Immunohaematology and Blood Transfusion, Kasturba Medical College Manipal Academy of Higher Education  Manipal Karnataka India"},{"name":"Department of Transfusion Medicine KIMS Health  Thiruvananthapuram Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepika","family":"Chenna","sequence":"additional","affiliation":[{"name":"Department of Immunohaematology and Blood Transfusion, Kasturba Medical College Manipal Academy of Higher Education  Manipal Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bemma","family":"Paonam","sequence":"additional","affiliation":[{"name":"Department of Immunohaematology and Blood Transfusion, Kasturba Medical College Manipal Academy of Higher Education  Manipal Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"e_1_2_11_3_1","unstructured":"WHO PPH Summit.pdf."},{"key":"e_1_2_11_4_1","unstructured":"WHO Road map of PPH.pdf."},{"key":"e_1_2_11_5_1","unstructured":"National health mission report on MMR.pdf."},{"key":"e_1_2_11_6_1","unstructured":"FOGSI guidelines 2022.pdf."},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.14116"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aev374"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2004.08.004"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2007.02297.x"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aes096"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-2115(97)02734-6"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012964"},{"key":"e_1_2_11_14_1","unstructured":"World Health Organization.WHO recommendations for the prevention and treatment of postpartum haemorrhage.World Health Organization;201241. 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