Association between fibrinogen level and severity of postpartum haemorrhage: secondary analysis of a prospective trial

British Journal of Anesthesia, 04/09/2012

Cortet M et al. – The fibrinogen level at postpartum haemorrhage (PPH) diagnosis is a marker of the risk of aggravation and should serve as an alert to clinicians.

Methods

  • This is a secondary analysis of a population-based study in 106 French maternity units identifying cases of PPH prospectively.
  • PPH was defined by a blood loss exceeding 500ml during the 24h after delivery or a peripartum haemoglobin decrease of more than 20glitre-1.
  • This analysis includes 738 women with PPH after vaginal delivery.
  • Fibrinogen levels were compared in patients whose PPH worsened and became severe and those whose PPH remained non-severe.
  • Severe PPH was defined as haemorrhage by occurrence of one of the following events: peripartum haemoglobin decrease ≥40glitre-1, transfusion of concentrated red cells, arterial embolization or emergency surgery, admission to intensive care, or death.

Results

  • The mean fibrinogen concentration at diagnosis was 4.2glitre-1 [standard deviation (sd)=1.2glitre-1] among the patients without worsening and 3.4glitre-1 (sd=0.9glitre-1) (P<0.001) in the group whose PPH became severe.
  • The fibrinogen level was associated with PPH severity independently of other factors [adjusted odds ratio=1.90 (1.16-3.09) for fibrinogen between 2 and 3glitre-1 and 11.99 (2.56-56.06) for fibrinogen <2glitre-1].

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