A: There hasnt been a NICE or RCOG review of guidance since 2017. There is increasing evidence that VHA is benificial but there is a question about cost effectivness. This will be part of the OBS UK study and hopefully guidence will change. By the end of the OBS UK study at least 50% of units will have VHA

A: <500ml vaginal birth and <1000ml after CS.

The inportant thing is to recognise when blood loss accumulates above these thresholds and PPH management escalated quickly.

A:

We have always used fibrinogen concentrate but this is not widly available

We use 4g FIBTEM 7-11 and 6G FIBTEM<7mm

This is equivelent to 2 or 3 pools of cryo.