{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:02:45Z","timestamp":1790686965887,"version":"4.1.0"},"reference-count":94,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Pregnancy is characterized by progressive hemostatic adaptation: increased fibrinogen synthesis, enhanced thrombin generation, and reduced fibrinolytic potential together prepare the maternal circulation for delivery-related blood loss. A fall in fibrinogen during pregnancy or the immediate postpartum period therefore does not carry the same meaning as an equivalent value outside of pregnancy. It may instead represent loss of a pregnancy-specific hemostatic reserve. Fibrinogen concentration is consistently associated with the severity of postpartum hemorrhage, but randomized trials have not shown that empirical replacement in all women with early postpartum hemorrhage improves clinical outcomes. This narrative review summarizes current evidence on pregnancy-associated fibrinogen deficiency and dysfunction, with emphasis on pathophysiology, trial findings, fibrinogen thresholds, replacement strategies, congenital fibrinogen disorders, and research gaps. Current data support using fibrinogen as both a severity marker and a selective treatment target, interpreted according to gestational age, bleeding phenotype, placental involvement, and resource setting. Direct evidence generated in low-resource settings is limited; no randomized trial of fibrinogen measurement or replacement has been conducted in such a setting.<\/jats:p>","DOI":"10.3390\/jcm15197565","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:09:25Z","timestamp":1790683765000},"page":"7565","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fibrinogen Deficiency and Dysfunction in Postpartum Hemorrhage: Evidence, Thresholds, and Management Across Resource Settings"],"prefix":"10.3390","volume":"15","author":[{"given":"Gulshat","family":"Bilyalova","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology No. 2, Astana Medical University, 010000 Astana, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aida","family":"Baibusunova","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology No. 2, Astana Medical University, 010000 Astana, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assel","family":"Boshanova","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology No. 2, Astana Medical University, 010000 Astana, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Galym","family":"Shegenov","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology No. 2, Astana Medical University, 010000 Astana, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bahit","family":"Anapina","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology No. 1, Astana Medical University, 010000 Astana, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damir","family":"Biktashev","sequence":"additional","affiliation":[{"name":"Department of Internal Diseases No. 2, Astana Medical University, 010000 Astana, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kulyash","family":"Jaxalykova","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Astana Medical University, 010000 Astana, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aigul","family":"Turgumbaeva","sequence":"additional","affiliation":[{"name":"Department of Internal Diseases No. 2, Astana Medical University, 010000 Astana, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assel","family":"Baubekova","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology No. 1, Astana Medical University, 010000 Astana, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhansulu","family":"Akylzhanova","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology No. 2, Astana Medical University, 010000 Astana, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saltanat","family":"Kulbayeva","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, South Kazakhstan Medical Academy, 160000 Shymkent, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhanar","family":"Kozhakhmetova","sequence":"additional","affiliation":[{"name":"Scientific Research Institute of Radiology Named After Zh. H. Khamzabayev, Astana Medical University, 010000 Astana, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinara","family":"Turzhanova","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine, Rehabilitation and Clinical Research, Kazakh National University of Sports, 010000 Astana, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruslan","family":"Alexeyev","sequence":"additional","affiliation":[{"name":"Viamedis LLP, 010000 Astana, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1056\/NEJMra1513247","article-title":"Postpartum hemorrhage","volume":"384","author":"Bienstock","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_2","unstructured":"WOMAN Trial Collaborators (2017). Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with postpartum haemorrhage: An international, randomized, double-blind, placebo-controlled trial. Lancet, 389, 2105\u20132116."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1111\/j.1538-7836.2007.02297.x","article-title":"The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage","volume":"5","author":"Charbit","year":"2007","journal-title":"J. Thromb. Haemost."},{"key":"ref_4","first-page":"360","article-title":"Hemostatic factors and replacement of major blood loss with plasma-poor red cell concentrates","volume":"81","author":"Hiippala","year":"1995","journal-title":"Anesth. Analg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1093\/bja\/aes096","article-title":"Association between fibrinogen level and severity of postpartum haemorrhage: Secondary analysis of a prospective trial","volume":"108","author":"Cortet","year":"2012","journal-title":"Br. J. Anaesth."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1182\/blood-2014-04-567891","article-title":"Fibrin-based clot formation as an early and rapid biomarker for progression of postpartum hemorrhage: A prospective study","volume":"124","author":"Collins","year":"2014","journal-title":"Blood"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1093\/bja\/aeu444","article-title":"Pre-emptive treatment with fibrinogen concentrate for postpartum haemorrhage: Randomized controlled trial","volume":"114","author":"Edwards","year":"2015","journal-title":"Br. J. Anaesth."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1814","DOI":"10.1111\/1471-0528.16699","article-title":"Early and systematic administration of fibrinogen concentrate in postpartum haemorrhage following vaginal delivery: The FIDEL randomised controlled trial","volume":"128","author":"Mercier","year":"2021","journal-title":"BJOG"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1093\/bja\/aex181","article-title":"Viscoelastometric-guided early fibrinogen concentrate replacement during postpartum haemorrhage: OBS2, a double-blind randomized controlled trial","volume":"119","author":"Collins","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S1521-6926(03)00021-5","article-title":"Haemostatic changes in pregnancy","volume":"16","author":"Bremme","year":"2003","journal-title":"Best Pract. Res. Clin. Haematol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1055\/s-2003-38897","article-title":"Hemostasis during normal pregnancy and puerperium","volume":"29","author":"Hellgren","year":"2003","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_12","first-page":"241","article-title":"Hemostatic changes in pregnancy","volume":"25","author":"James","year":"2011","journal-title":"Hematol. Oncol. Clin. N. Am."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S46","DOI":"10.1016\/j.ijgo.2015.03.007","article-title":"Essential basic and emergency obstetric and newborn care: From education and training to service delivery and quality of care","volume":"130","author":"Otolorin","year":"2015","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"American College of Obstetricians and Gynecologists (2017). Practice Bulletin No. 183: Postpartum hemorrhage. Obstet. Gynecol., 130, e168\u2013e186.","DOI":"10.1097\/AOG.0000000000002351"},{"key":"ref_15","first-page":"e106","article-title":"Prevention and management of postpartum haemorrhage","volume":"124","author":"Mavrides","year":"2017","journal-title":"BJOG"},{"key":"ref_16","unstructured":"Royal College of Obstetricians and Gynaecologists (2011). Antepartum Haemorrhage, Royal College of Obstetricians and Gynaecologists. Green-Top Guideline No. 63."},{"key":"ref_17","unstructured":"World Health Organization, International Federation of Gynecology and Obstetrics, and International Confederation of Midwives (2025). Consolidated Guidelines for the Prevention, Diagnosis and Treatment of Postpartum Haemorrhage, World Health Organization."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/ijgo.14116","article-title":"FIGO recommendations on the management of postpartum hemorrhage 2022","volume":"157","author":"Escobar","year":"2022","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1111\/aogs.14828","article-title":"Management and outcomes of women with low fibrinogen concentration during pregnancy or immediately postpartum: A UK national population-based cohort study","volume":"103","author":"Diguisto","year":"2024","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa2303966","article-title":"Randomized trial of early detection and treatment of postpartum hemorrhage","volume":"389","author":"Gallos","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_21","unstructured":"World Health Organization (2023). WHO Recommendations on the Assessment of Postpartum Blood Loss and Use of a Treatment Bundle for Postpartum Haemorrhage, World Health Organization."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"El Ayadi, A.M., Nathan, H.L., Seed, P.T., Butrick, E.A., Hezelgrave, N.L., Shennan, A.H., and Miller, S. (2016). Vital sign prediction of adverse maternal outcomes in women with hypovolemic shock: The role of shock index. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0148729"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0301-2115(97)02734-6","article-title":"Coagulation and fibrinolysis changes in normal pregnancy","volume":"73","author":"Cerneca","year":"1997","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1182\/blood.V69.2.460.460","article-title":"Fibrinolysis in pregnancy: A study of plasminogen activator inhibitors","volume":"69","author":"Kruithof","year":"1987","journal-title":"Blood"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.thromres.2017.06.027","article-title":"Normal pregnancy is associated with an increase in thrombin generation from the very early stages of the first trimester","volume":"157","author":"Bagot","year":"2017","journal-title":"Thromb. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"135.e1","DOI":"10.1016\/j.ajog.2012.05.027","article-title":"Tissue factor-dependent thrombin generation across pregnancy","volume":"207","author":"McLean","year":"2012","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1160\/TH09-10-0704","article-title":"Haemostatic reference intervals in pregnancy","volume":"103","author":"Szecsi","year":"2010","journal-title":"Thromb. Haemost."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3192350","DOI":"10.1155\/2020\/3192350","article-title":"Reference values of D-dimers and fibrinogen in physiological pregnancy: The potential impact of selected risk factors\u2014A pilot study","volume":"2020","author":"Siennicka","year":"2020","journal-title":"Biomed. Res. Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1016\/S0002-9378(12)90756-5","article-title":"Amniotic fluid contains tissue factor, a potent initiator of coagulation","volume":"165","author":"Lockwood","year":"1991","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1038\/s41598-023-50911-w","article-title":"Comparative analysis of hyperfibrinolysis with activated coagulation between amniotic fluid embolism and severe placental abruption","volume":"14","author":"Ide","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1111\/jth.12155","article-title":"Guidance for diagnosis and treatment of disseminated intravascular coagulation from harmonization of recommendations from three guidelines","volume":"11","author":"Wada","year":"2013","journal-title":"J. Thromb. Haemost."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1055\/s-0037-1616068","article-title":"Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation","volume":"86","author":"Taylor","year":"2001","journal-title":"Thromb. Haemost."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1182\/blood-2017-10-804096","article-title":"How I treat disseminated intravascular coagulation","volume":"131","author":"Levi","year":"2018","journal-title":"Blood"},{"key":"ref_34","first-page":"99","article-title":"Disseminated intravascular coagulation in pregnancy: Insights in pathophysiology, diagnosis and management","volume":"212","author":"Erez","year":"2022","journal-title":"Thromb. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.jtha.2022.11.036","article-title":"Acute obstetric coagulopathy during postpartum hemorrhage is caused by hyperfibrinolysis and dysfibrinogenemia: An observational cohort study","volume":"21","author":"Jenkins","year":"2023","journal-title":"J. Thromb. Haemost."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Roberts, I., Shakur, H., Fawole, B., Kuti, M., Olayemi, O., Bello, A., Ogunbode, O., Kotila, T., Aimakhu, C.O., and Olutogun, T. (2018). Haematological and fibrinolytic status of Nigerian women with post-partum haemorrhage. BMC Pregnancy Childbirth, 18.","DOI":"10.1186\/s12884-018-1794-1"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2064","DOI":"10.1016\/j.jtha.2023.03.029","article-title":"Managing the coagulopathy of postpartum hemorrhage: An evolving role for viscoelastic hemostatic assays","volume":"21","author":"Bell","year":"2023","journal-title":"J. Thromb. Haemost."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1111\/anae.12859","article-title":"Introduction of an algorithm for ROTEM-guided fibrinogen concentrate administration in major obstetric haemorrhage","volume":"70","author":"Mallaiah","year":"2015","journal-title":"Anaesthesia"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1213\/ANE.0000000000001473","article-title":"National and international guidelines for patient blood management in obstetrics: A qualitative review","volume":"124","author":"Shaylor","year":"2017","journal-title":"Anesth. Analg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1111\/anae.12913","article-title":"Haemostatic management of obstetric haemorrhage","volume":"70","author":"Collis","year":"2015","journal-title":"Anaesthesia"},{"key":"ref_41","first-page":"112","article-title":"Patient blood management in obstetrics: Prevention and treatment of postpartum haemorrhage. A NATA consensus statement","volume":"17","author":"Stensballe","year":"2019","journal-title":"Blood Transfus."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"217","DOI":"10.2147\/JBM.S90693","article-title":"Acquired hypofibrinogenemia: Current perspectives","volume":"7","author":"Besser","year":"2016","journal-title":"J. Blood Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1160\/TH08-06-0386","article-title":"Coagulation assessment by rotational thromboelastometry in normal pregnancy","volume":"101","author":"Huissoud","year":"2009","journal-title":"Thromb. Haemost."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1111\/jog.13788","article-title":"Fibrinogen for the management of critical obstetric hemorrhage","volume":"45","author":"Matsunaga","year":"2019","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2115","DOI":"10.1111\/j.1538-7836.2006.02094.x","article-title":"The molecular basis of quantitative fibrinogen disorders","volume":"4","author":"Asselta","year":"2006","journal-title":"J. Thromb. Haemost."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1055\/s-0036-1571340","article-title":"Laboratory and genetic investigation of mutations accounting for congenital fibrinogen disorders","volume":"42","author":"Casini","year":"2016","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1111\/jth.12916","article-title":"Dysfibrinogenemia: From molecular anomalies to clinical manifestations and management","volume":"13","author":"Casini","year":"2015","journal-title":"J. Thromb. Haemost."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1894","DOI":"10.1111\/j.1538-7836.2005.01365.x","article-title":"Fibrinogen and fibrin structure and functions","volume":"3","author":"Mosesson","year":"2005","journal-title":"J. Thromb. Haemost."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1111\/jth.12229","article-title":"Fibrin(ogen) and thrombotic disease","volume":"11","year":"2013","journal-title":"J. Thromb. Haemost."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1182\/blood-2014-06-582866","article-title":"Natural history of patients with congenital dysfibrinogenemia","volume":"125","author":"Casini","year":"2015","journal-title":"Blood"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1007\/978-3-319-49674-0_13","article-title":"Fibrin formation, structure and properties","volume":"82","author":"Weisel","year":"2017","journal-title":"Subcell. Biochem."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"100822","DOI":"10.1016\/j.ajogmf.2022.100822","article-title":"Beyond uterine atony: Characterizing postpartum hemorrhage coagulopathy","volume":"5","author":"Coleman","year":"2023","journal-title":"Am. J. Obstet. Gynecol. MFM"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1111\/j.1600-0412.2010.01030.x","article-title":"Placental abruption: Epidemiology, risk factors and consequences","volume":"90","author":"Tikkanen","year":"2011","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_54","first-page":"100264","article-title":"Pre-delivery fibrinogen level is a predictor for severity of placental abruption","volume":"20","author":"Tayyar","year":"2023","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol. X"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1097\/AOG.0b013e3181d9f629","article-title":"Incidence and risk factors for amniotic-fluid embolism","volume":"115","author":"Knight","year":"2010","journal-title":"Obstet. Gynecol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1097\/GRF.0b013e3181e0ead2","article-title":"Amniotic fluid embolism","volume":"53","author":"Clark","year":"2010","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2940","DOI":"10.1080\/14767058.2016.1269166","article-title":"Value of fibrinogen in cases of maternal death related to amniotic fluid embolism","volume":"30","author":"Tanaka","year":"2017","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"11026","DOI":"10.1038\/s41598-019-47378-z","article-title":"Decline in maternal death due to obstetric haemorrhage between 2010 and 2017 in Japan","volume":"9","author":"Hasegawa","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2544","DOI":"10.1161\/ATVBAHA.115.306035","article-title":"Cell-free DNA modulates clot structure and impairs fibrinolysis in sepsis","volume":"35","author":"Gould","year":"2015","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Erez, O., Novack, L., Beer-Weisel, R., Dukler, D., Press, F., Zlotnik, A., Than, N.G., Tomer, A., and Mazor, M. (2014). DIC score in pregnant women: A population-based modification of the International Society on Thrombosis and Haemostasis score. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0093240"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1160\/TH16-02-0082","article-title":"Thromboembolism in patients with congenital afibrinogenaemia: Long-term observational data and systematic review","volume":"116","author":"Nagler","year":"2016","journal-title":"Thromb. Haemost."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1046\/j.1365-2141.1999.01681.x","article-title":"Bleeding and thrombosis in 55 patients with inherited afibrinogenaemia","volume":"107","author":"Lak","year":"1999","journal-title":"Br. J. Haematol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1002\/humu.20483","article-title":"Mutations in the fibrinogen gene cluster accounting for congenital afibrinogenemia: An update and report of 10 novel mutations","volume":"28","year":"2007","journal-title":"Hum. Mutat."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1055\/s-0029-1225758","article-title":"Congenital fibrinogen disorders","volume":"35","year":"2009","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2126","DOI":"10.1016\/j.jtha.2023.04.035","article-title":"Obstetrical complications in hereditary fibrinogen disorders: The Fibrinogest study","volume":"21","author":"Claeyssens","year":"2023","journal-title":"J. Thromb. Haemost."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"102960","DOI":"10.1016\/j.rpth.2025.102960","article-title":"Gynecologic and obstetric complications in women with congenital fibrinogen disorders: Insights from the Prospective Rare Bleeding Disorders Database","volume":"9","author":"Mohsenian","year":"2025","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1097\/MBC.0000000000000676","article-title":"Congenital hypofibrinogenemia in pregnancy: A report of 11 cases","volume":"29","author":"Cai","year":"2018","journal-title":"Blood Coagul. Fibrinolysis"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1016\/j.jtha.2024.01.008","article-title":"Management of pregnancy and delivery in congenital fibrinogen disorders: Communication from the ISTH SSC Subcommittee on Factor XIII and Fibrinogen","volume":"22","author":"Casini","year":"2024","journal-title":"J. Thromb. Haemost."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1002\/rth2.12300","article-title":"Pregnancy outcome in afibrinogenemia: Are we giving enough fibrinogen concentrate? A case series","volume":"4","author":"Saes","year":"2020","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Karampas, G., Karkalemis, K., Bagiasta, A., Lefaki, M.-E., Metallinou, D., Staikou, C., Iliodromiti, Z., Sokou, R., Tataropoulou, K., and Boutsikou, T. (2025). Severe hereditary hypofibrinogenemia in pregnancy: A case report of thromboelastometry-guided fibrinogen supplementation. Diagnostics, 15.","DOI":"10.3390\/diagnostics15131671"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1055\/s-0036-1571339","article-title":"Clinical features and management of congenital fibrinogen deficiencies","volume":"42","author":"Casini","year":"2016","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.bja.2022.10.031","article-title":"Thromboelastometry-guided treatment algorithm in postpartum haemorrhage: A randomised, controlled pilot trial","volume":"130","author":"Jokinen","year":"2023","journal-title":"Br. J. Anaesth."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1111\/anae.15595","article-title":"Early cryoprecipitate transfusion versus standard care in severe postpartum haemorrhage: A pilot cluster-randomised trial","volume":"77","author":"Green","year":"2022","journal-title":"Anaesthesia"},{"key":"ref_74","first-page":"CD016168","article-title":"Transfusion of blood and blood products for the management of postpartum haemorrhage","volume":"2025","author":"Williams","year":"2025","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_75","unstructured":"Japan Society of Obstetrics and Gynecology, and Japan Association of Obstetricians and Gynecologists (2022). Japanese Clinical Practice Guide for Critical Obstetrical Hemorrhage 2022, Japan Society of Obstetrics and Gynecology."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1111\/j.1471-0528.2009.02187.x","article-title":"Bedside assessment of fibrinogen level in postpartum haemorrhage by thrombelastometry","volume":"116","author":"Huissoud","year":"2009","journal-title":"BJOG"},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Gillissen, A., Golyardi, B., van den Akker, T., Caram-Deelder, C., Henriquez, D.D.C.A., Bloemenkamp, K.W.M., Duvekot, J.J., de Maat, M.P.M., Eikenboom, J., and van der Bom, J.G. (2023). Association between Clauss fibrinogen concentration and ROTEM FIBTEM A5 in women with postpartum haemorrhage: Validation of cut-off points. medRxiv.","DOI":"10.1101\/2023.10.12.23296942"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1111\/anae.16455","article-title":"Relationship between the dual platelet-inhibited ROTEM Sigma FIBTEM assay and Clauss fibrinogen during postpartum haemorrhage","volume":"80","author":"Bell","year":"2024","journal-title":"Anaesthesia"},{"key":"ref_79","first-page":"442","article-title":"Postpartum Hemorrhage: Prevention and Treatment","volume":"95","author":"Evensen","year":"2017","journal-title":"Am. Fam. Physician"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1160\/TH13-12-0997","article-title":"Fibrinogen measurement in cardiac surgery with cardiopulmonary bypass: Analysis of repeatability and agreement of Clauss method within and between six different laboratories","volume":"112","author":"Solomon","year":"2014","journal-title":"Thromb. Haemost."},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Spasiano, A., Matellon, C., Orso, D., Brussa, A., Cafagna, M., Marangone, A., Dogareschi, T., Bove, T., Giacomello, R., and Fontana, D. (2019). Functional fibrinogen (FLEV-TEG) versus the Clauss method in an obstetric population: A comparative study. BMC Anesthesiol., 19.","DOI":"10.1186\/s12871-019-0769-8"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"459.e1","DOI":"10.1016\/j.ajog.2013.07.001","article-title":"Methylergonovine maleate and the risk of myocardial ischemia and infarction","volume":"209","author":"Bateman","year":"2013","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Zomer, P.M.L., van Teeffelen, M.P.A., Otterspoor, L.C., and Kamps, M.J.A. (2023). Postpartum cardiogenic shock due to coronary artery spasm after methylergometrine and sulprostone administration. Neth. Heart J.","DOI":"10.1007\/s12471-023-01805-z"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijgo.2011.10.005","article-title":"Misoprostol for postpartum hemorrhage: Moving from evidence to practice","volume":"116","author":"Starrs","year":"2012","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"293.e1","DOI":"10.1016\/j.ajog.2019.11.1287","article-title":"Uterine balloon tamponade for the treatment of postpartum hemorrhage: A systematic review and meta-analysis","volume":"222","author":"Suarez","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1111\/voxs.12376","article-title":"Do we need cryoprecipitate in the era of fibrinogen concentrate and other specific factor replacement options?","volume":"13","author":"Wong","year":"2018","journal-title":"ISBT Sci. Ser."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1001\/jama.2019.17312","article-title":"Effect of fibrinogen concentrate vs cryoprecipitate on blood component transfusion after cardiac surgery: The FIBRES randomized clinical trial","volume":"322","author":"Callum","year":"2019","journal-title":"JAMA"},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Chen, Y., Yang, W., Zhao, C., Wang, F., Ren, P., Liu, X., Cao, T., Ji, S., Chen, L., and Kang, D. (2025). Treatment effects of fibrinogen concentrates vs. cryoprecipitate for correcting hypofibrinogenemia in cardiac surgery patients: A systematic review and meta-analysis. Front. Cardiovasc. Med., 12.","DOI":"10.3389\/fcvm.2025.1671405"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1053\/j.jvca.2023.10.031","article-title":"Prospective, Randomized Study of Fibrinogen Concentrate Versus Cryoprecipitate for Correcting Hypofibrinogenemia in Cardiac Surgery Patients","volume":"38","author":"Ayaganov","year":"2024","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1001\/jamasurg.2022.6818","article-title":"Cost-effectiveness of fibrinogen concentrate vs cryoprecipitate for treating acquired hypofibrinogenemia in bleeding adult cardiac surgical patients","volume":"158","author":"Abrahamyan","year":"2023","journal-title":"JAMA Surg."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1111\/trf.16376","article-title":"Effects of pathogen reduction technology and storage duration on the ability of cryoprecipitate to rescue induced coagulopathies in vitro","volume":"61","author":"Thomas","year":"2021","journal-title":"Transfusion"},{"key":"ref_92","unstructured":"CSL Behring (2016). RIASTAP (Fibrinogen Concentrate, Human), Lyophilized Powder for Reconstitution: Prescribing Information, CSL Behring."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1056\/NEJMoa1805489","article-title":"Heat-stable carbetocin versus oxytocin to prevent hemorrhage after vaginal birth","volume":"379","author":"Widmer","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_94","first-page":"202","article-title":"New global guidance supports community and lay health workers in postpartum hemorrhage prevention","volume":"122","author":"Smith","year":"2013","journal-title":"Int. J. Gynaecol. Obstet."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7565\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:46:46Z","timestamp":1790686006000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7565"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":94,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197565"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197565","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]}}}