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.

• 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.

• 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].