Background and Goal of study:
Postpartum haemorrhage  remains  the first  cause of maternal mortality worldwide specially when it leads to coagulopathy. Early tratment of coagulopathy with  fibrinogen transfusion is obligatory. This trial aims to investigate if early treatment with fibrinogen concentrate reduces the blood loss and the  need for blood transfusion.
Materials and Methods: We included patients that needed 2g of fibrinogen transfusion in the treatment of severe postpartum hemorrhage due to uterine atony after cesarean section delivery. Fibrinogen was transfused to treat coagulopathy or after massive transfusion or earlier  when practitioners in charge of the patient  estimate that the bleeding may lead to coagulopathy. patients included were devided into 2 groups :
Group E (early) : when fibrinogen was given within the first hour after sulprostone administration
Group L : when fibrinogen was given after the first hour  following the administration of sulprostone 
Then, we compared the blood loss estimated by  Gross formula and the Red blood cell transfusion requirements  in both groups.
Results and discussion:  In this study, 9 patients were included (4 patients en group E and 5 patients in group L). Blood loss was correlated to the delay of fibrinogen administration. (Pearson correlation coefficient was 0.785) Blood loss was 2836 ml in group E versus 5855 ml in group L (p=0.042).   Red blood cell transfusion requirements  was 4.25 units/patient in group E versus 8.1 in group L (p =0.01)  
Conclusion:  Early administration of fibrinogen seems to reduce blood loss and transfusions after uterine atony in cesarean section delivery.

Can early administration of fibrinogen improve post partum hemorrhage? A prospective observational study (preliminary results)