要旨

産科の大量出血は、外傷とは凝固の生理が異なります。 フィブリノゲンは速く正確に測れますが、「測れば転帰が良くなる」はまだ示されていません。 重症度を分けるのはフィブリノゲンで、線溶マーカーではありません。 早期トラネキサム酸は、大規模試験で裏づけられた数少ない介入です。 新しい製剤や輸血法（クリオプレシピテート・回収式自己血輸血・全血）は有望ですが、母体の転帰を改善するとはまだ示されていません。

本論の要点

記事本文（数値解析・原典精読・国内実装の論点）は theLetter「産科の羅針盤」で全文無料で配信しています。本ページでは、論点の構造と図表アーカイブを公開しています。

本稿の要点

本文を全文無料で読む

本連載は theLetter「産科の羅針盤」で全文無料で配信しています（メールアドレスのみで購読可・配信はいつでも解除できます）。

theLetter で読む（無料）

主要参考文献

  1. Cox C, Neave L, Hunt BJ. New approaches in the haemostatic management of postpartum haemorrhage. BMJ Med 2026. DOI: 10.1136/bmjmed-2025-002256（PMID: 42299317）
  2. de Lloyd L, et al. Standard haemostatic tests following major obstetric haemorrhage. Int J Obstet Anesth 2011（PMID: 21439811）
  3. Wikkelsø AJ, et al. Pre-emptive treatment with fibrinogen concentrate for postpartum haemorrhage: randomized controlled trial. Br J Anaesth 2015（PMID: 25586727）
  4. Ducloy-Bouthors AS, et al. Early and systematic administration of fibrinogen concentrate in postpartum haemorrhage following vaginal delivery: the FIDEL randomised controlled trial. BJOG 2021（PMID: 33713384）
  5. de Lloyd L, et al. Acute obstetric coagulopathy during postpartum hemorrhage is caused by hyperfibrinolysis and dysfibrinogenemia: an observational cohort study. J Thromb Haemost 2023（PMID: 36696216）
  6. Collins PW, et al. Acute obstetric coagulopathy is associated with excess plasmin generation and proteolysis of fibrinogen and factor V. Blood Adv 2025（PMID: 39913691）
  7. Nakamura E, et al. Comparative retrospective study on the validity of point-of-care testing device for massive obstetrical hemorrhage: dry hematology vs thromboelastography. Am J Obstet Gynecol MFM 2023. DOI: 10.1016/j.ajogmf.2022.100778（PMID: 36273811）
  8. Hayakawa M, et al. Rapid Evaluation of Fibrinogen Levels Using the CG02N Whole Blood Coagulation Analyzer. Semin Thromb Hemost 2015. DOI: 10.1055/s-0035-1547372（PMID: 25839869）
  9. Mihara Y, et al. Accuracy of rapid blood coagulation testing device FibCare® in a tertiary emergency department. Acute Med Surg 2024（PMID: 38450033）
  10. Katz D, et al. The role of viscoelastic hemostatic assays for postpartum hemorrhage management and bedside intrapartum care. Am J Obstet Gynecol 2024. DOI: 10.1016/j.ajog.2022.09.008（PMID: 38462250）
  11. Collins P, Abdul-Kadir R, Thachil J, et al. Management of coagulopathy associated with postpartum haemorrhage: guidance from the SSC of the ISTH. J Thromb Haemost 2016（PMID: 27028301）
  12. Takahashi Y, Obata S, et al. Maternal Severity and Diagnostic Validity of the Revised Japanese Criteria for Obstetric Disseminated Intravascular Coagulation: A Retrospective Observational Study. J Obstet Gynaecol Res 2026. DOI: 10.1111/jog.70388（PMID: 42381181）
  13. WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet 2017（PMID: 28456509）
  14. CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010. DOI: 10.1016/S0140-6736(10)60835-5（PMID: 20554319）
  15. Gayet-Ageron A, et al. Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients. Lancet 2018. DOI: 10.1016/S0140-6736(17)32455-8（PMID: 29126600）
  16. World Health Organization. WHO Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage. 2025（Recommendation 27）
  17. Nakajima K, et al. Efficacy of prompt administration of cryoprecipitate in severe postpartum hemorrhage of preeclampsia patients. J Obstet Gynaecol Res 2023. DOI: 10.1111/jog.15792（PMID: 37723942）
  18. Levy I, et al. Impact of Cell Saver technology on pro-hemostatic factors transfusion in placenta accreta spectrum interventions. Int J Gynaecol Obstet 2026. DOI: 10.1002/ijgo.71181（PMID: 42394398）
  19. Nair S, et al. Routine whole blood use for primary postpartum haemorrhage in South India: A 12-year descriptive report. Transfus Clin Biol 2026. DOI: 10.1016/j.tracli.2026.06.001（PMID: 42248348）
  20. Clark SL, Romero R, Dildy GA, et al. Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies. Am J Obstet Gynecol 2016. DOI: 10.1016/j.ajog.2016.06.037（PMID: 27372270）
  21. Nii M, et al. Changes in use and outcomes after fibrinogen concentrate insurance coverage for critical obstetrical hemorrhage: a nationwide questionnaire survey in Japan. Sci Rep 2024. DOI: 10.1038/s41598-024-57244-2（PMID: 38509152）
  22. 日本産科婦人科学会・日本産婦人科医会. 産婦人科診療ガイドライン産科編2026. CQ416-1・CQ416-2（p268-276）
  23. 日本産婦人科医会 妊産婦死亡症例検討評価委員会. 母体安全への提言 Vol.6（2015）・Vol.9（2018）・Vol.15（2024）