Collins PW, et al. - This study hypothesized that early fibrinogen replacement, guided by viscoelastometric testing, attenuates blood product usage and bleed size in postpartum haemorrhage (PPH). No improvement was evident in outcomes subsequent to infusion of fibrinogen concentrate triggered by Fibtem A5 ≤15 mm. As indicated in pre-specified subgroup analyses, if the Fibtem A5 is >12 mm or Clauss fibrinogen >2 g litre^-1, there is no need for fibrinogen replacement, but an impact below these levels could not be excluded. In addition, the raised fibrinogen at term seemed to be a physiological buffer rather than required for haemostasis.