Due to the emergency nature of the intervention, informed consent for administering the intervention is waived.The primary objective is to assess the feasibility of administering cryoprecipitate within 90 min of RBC request, as compared with standard treatment where cryoprecipitate is given later or not at all. We exclude women who decline blood transfusions in advance or have inherited Factor XIII or fibrinogen deficiency. The control group will retain their standard of care.We include women at >24 weeks gestation who are actively bleeding within 24 hours of delivery and for whom transfusion of red blood cells (RBCs) has been started. The intervention group will adapt their major obstetric haemorrhage procedures to administer cryoprecipitate early for primary PPH. Four large London maternity units are randomised to either the intervention or control group. Prior to performing a full-scale trial, a pilot study is needed to determine feasibility of the intervention and recruitment.ĪCROBAT is a cluster-randomised pilot study with a qualitative evaluation. No studies have investigated the clinical impact of early cryoprecipitate transfusion in PPH. Early fibrinogen replacement could potentially improve outcomes. Fibrinogen levels have been shown to drop early and significantly during PPH, which is associated with worse outcomes. The incidence of severe postpartum haemorrhage (PPH) that requires blood transfusion is on the increase. 10 Department of Women's and Neonatal Health, Royal London Hospital, Barts Health NHS Trust, London, UK.9 WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.8 Institute for Health and Human Development, University of East London, London, UK.7 Department of Statistics and Data Science, Complutense University of Madrid, Madrid, Spain.

6 Department of Statistics and Operational Research, Complutense University of Madrid, Madrid, Spain.5 Clinical Biostatistics Unit, Hospital Ramón y Cajal (IRYCIS), CIBER Epidemiology and Public Health, Madrid, Spain.4 Barts Research Centre for Women's Health (BARC), Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.3 Department of Haematology, Barts Health NHS Trust, London, UK.1 Blizard Institute, Queen Mary University of London, London, UK 2 Components, NHS Blood and Transplant, London, UK.

Acrobat trial