Association between fibrinogen levels and the severity of postpartum haemorrhage

Abstract

Fibrin fibrinogen degradation products Blood transfusion Blood coagulation Maternal mortality a b s t r a c t Objective: To determine if the level of fibrinogen at the onset of postpartum haemorrhage is associated with bleeding severity and a higher number of complications; to determine outcome-related cut-off points. Materials and methods: Secondary analysis of a cohort study conducted with 79 mothers admitted to the Intensive Care Unit between February 1st, 2012 and January 31st, 2013, with a diagnosis of postpartum haemorrhage, defined as all cases of blood loss greater than 1000 mL. Fibrinogen levels were measured at the onset of the postpartum haemorrhage. Fibrinogen values were compared between patients with severe obstetric bleeding and those with mild-to-moderate bleeding, in order to establish the correlation with severity of blood loss and complications. Results: Overall, 24.1% of the patients showed severe postpartum haemorrhage compared to 75.9% of the patients classified as having mild-to-moderate haemorrhage. There were 12 complications (15.2%), including 9 cases of acute renal injury, 2 cases of disseminated intravascular coagulation, and one death, all of them only in patients with severe obstetric haemorrhage. Regarding the initial fibrinogen value, the AUC-ROC for fibrinogen levels and their relationship with the severity was 0.71, with a cut-off point of <200 mg/dL to predict severity (100% positive predictive value). ଝ Please cite this article as: García-Velásquez V, González-Agudelo M, Cardona-Ospina A, Ardila-Castellanos R. Asociacion entre el nivel de fibrinogeno y severidad en la hemorragia posparto. Rev Colomb Anestesiol. 2015;43:136-141. r e v c o l o m b a n e s t e s i o l . 2 0 1 5;4 3(2):136-141 dad fue de 0,71 con un punto de corte < 200 mg/dL para predecir severidad (valor predictivo positivo 100%) Conclusión: el nivel de fibrinógeno inicial en hemorragia obstétrica posparto es un predictor de severidad que ayuda a alertar el tratamiento en estas pacientes.