Critical Care Obstetrics and Gynecology

Independent Risk Factors for Postpartum Haemorrhage

Background: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality. To evaluate the possibility that antepartum fibrinogen is associated with risk of postpartum hemorrhage.

Methods and Findings: Retrospective analysis was performed among 949 women with vaginal deliveries of singletons at gestational week (GW) ≥ 36 to examine associations of PPH, defined as estimated blood loss (EBL) ≥ 700 mL, with antepartum blood fibrinogen, platelet count, and hemoglobin levels within 7 days prior to delivery and demographic characteristics, including, parity, maternal age, pre-pregnancy body mass index, duration of labor, instrumental delivery, and birthweight. Logistic multiple regression analysis was performed to identify independent risk factors and odds ratios (OR). PPH occurred in 127 (13%) women and was less frequent as levels of fibrinogen increased with OR (confidence interval) 0.97 (0.95 – 0.99) for 1.0 g/L increase in fibrinogen level by logistic multiple regression analysis. The other independent risk factors for PPH included nulliparity,1.08 (1.03 – 1.12) and increased birthweight 1.02 (1.01 – 1.03) for each 100 g increase in birthweight. PPH was more common in nulliparous than multiparous women (16% [77/474] vs. 11% [50/475]) and in women with instrumental deliveries (27% [8/30] vs. 13% [119/919]). EBL was significantly negatively correlated with fibrinogen and hemoglobin levels and positively with GW at delivery and infant birthweight.

Conclusions: Antepartum fibrinogen level was an independent risk factor for PPH, and each 1.0 g/L decrease of antenatal fibrinogen level increased the risk of PPH by 2.9% independent of other factors.

Author(s):

Kinuko Nakagawa, Takashi Yamada, Kazutoshi Cho, Rina Akaishi, Yuko Kohgo, Kaoru Hanatani and Hisanori Minakami

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