{
    "abstract": "Fibrinogen concentrate (FC) for acquired hypofibrinogenemia associated with critical obstetrical hemorrhage (COH) was covered by public medical insurance in September 2021 in Japan. We aimed to investigate changes in the policy of FC use and its effect on COH after insurance coverage. A primary survey covering September 2020 to August 2021 and a secondary survey covering September 2021 to August 2022 were conducted at 428 higher-level medical facilities. We investigated the policy of FC use in transfusion strategy and the maternal outcomes in COH. Among the hospitals that responded to both surveys, the number of facilities that use FC increased from 51.5 (101/196) to 78.6% (154/196) (P\u2009<\u20090.0001). The number of COH cases treated using FC increased from 14.3 to 24.3% (P\u2009<\u20090.0001) and that transfused with\u2009\u2265\u200910 units of red blood cells (RBCs) decreased from 36.8 to 29.8% (P\u2009=\u20090.001). The incidence of pulmonary edema reduced by 3.7-2.0% (P\u2009=\u20090.021), and transfusion-induced allergy by 1.9-0.7% (P\u2009=\u20090.008). No changes were observed in the incidence of thromboembolism, arterial embolization, or hysterectomy. The increased use of FC after insurance coverage led to changes in the transfusion strategy, which may be associated with decreases in transfusions of RBCs, pulmonary edema, and transfusion-induced allergies.",
    "authors": [
        {
            "affiliation": "Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Japan. m-nii1984@med.mie-u.ac.jp.\nThe Japan Society of Obstetrical, Gynecological and Neonatal Hematology (JSOGNH), Kitakyushu, Japan. m-nii1984@med.mie-u.ac.jp.",
            "firstname": "Masafumi",
            "initials": "M",
            "lastname": "Nii"
        },
        {
            "affiliation": "The Japan Society of Obstetrical, Gynecological and Neonatal Hematology (JSOGNH), Kitakyushu, Japan.\nDepartment of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan.",
            "firstname": "Tomoaki",
            "initials": "T",
            "lastname": "Oda"
        },
        {
            "affiliation": "The Japan Society of Obstetrical, Gynecological and Neonatal Hematology (JSOGNH), Kitakyushu, Japan.\nDepartment of Obstetrics and Gynecology, Kansai Medical University, Osaka, Japan.",
            "firstname": "Mamoru",
            "initials": "M",
            "lastname": "Morikawa"
        },
        {
            "affiliation": "The Japan Society of Obstetrical, Gynecological and Neonatal Hematology (JSOGNH), Kitakyushu, Japan.\nDepartment of Obstetrics and Gynecology, Nakabayashi Hospital, Tokyo, Japan.",
            "firstname": "Yasushi",
            "initials": "Y",
            "lastname": "Nakabayashi"
        },
        {
            "affiliation": "The Japan Society of Obstetrical, Gynecological and Neonatal Hematology (JSOGNH), Kitakyushu, Japan.\nDepartment of Obstetrics and Gynecology, Aiiku Hospital, Tokyo, Japan.",
            "firstname": "Tomoko",
            "initials": "T",
            "lastname": "Adachi"
        },
        {
            "affiliation": "The Japan Society of Obstetrical, Gynecological and Neonatal Hematology (JSOGNH), Kitakyushu, Japan.\nDepartment of Obstetrics and Gynecology, Hamamatsu Medical Center, Hamamatsu, Japan.",
            "firstname": "Takao",
            "initials": "T",
            "lastname": "Kobayashi"
        },
        {
            "affiliation": "The Japan Society of Obstetrical, Gynecological and Neonatal Hematology (JSOGNH), Kitakyushu, Japan.\nDepartment of Obstetrics and Gynecology, Juntendo University Graduate School of Medicine, Tokyo, Japan.",
            "firstname": "Atsuo",
            "initials": "A",
            "lastname": "Itakura"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2024. The Author(s).",
    "doi": "10.1038/s41598-024-57244-2\n10.1016/S2214-109X(14)70227-X\n10.1136/bmjopen-2015-010304\n10.1038/s41598-019-47378-z\n10.1080/01443619750113113\n10.1097/CCM.0000000000004665\n10.1093/bja/aes361\n10.1111/j.1538-7836.2011.04398.x\n10.1111/jog.13788\n10.1038/srep46749\n10.1177/0310057X0102900507\n10.1111/j.1447-0756.2012.02058.x\n10.1016/j.ijoa.2010.12.002\n10.1111/j.1365-3148.2012.01178.x\n10.1111/j.1365-2044.2010.06538.x\n10.1097/EJA.0000000000001803\n10.1016/j.ejogrb.2015.12.012\n10.1111/trf.17483\n10.5402/2012/854064\n10.1016/j.ajogmf.2022.100778\n10.1097/01.ogx.0000189154.98227.4b\n10.1111/j.1365-3148.2012.01168.x\n10.1213/ANE.0000000000003508",
    "journal": "Scientific reports",
    "keywords": [
        "Critical obstetrical hemorrhage",
        "Fibrinogen concentrates",
        "Public medical insurance coverage",
        "Pulmonary edema",
        "Red blood cell concentrate",
        "Transfusion-induced allergy"
    ],
    "methods": null,
    "publication_date": "2024-03-21",
    "pubmed_id": "38509152\n25103301\n27000786\n31363105\n15511834\n33031152\n23075633\n21668737\n30155944\n28436465\n11669429\n23278972\n21439811\n22994449\n27981719\n20963925\n36855941\n26773243\n37450885\n30747700\n22462007\n36273811\n16359565\n22697297\n29863608",
    "results": null,
    "title": "Changes in use and outcomes after fibrinogen concentrate insurance coverage for critical obstetrical hemorrhage: a nationwide questionnaire survey in Japan.",
    "xml": "<Element 'PubmedArticle' at 0x788504e647c0>"
}