Pre-Anaesthetic Assessment of Coagulation Abnormalities in Obstetric Patients

Higher D-dimer level in the early third trimester predicts the occurrence of postpartum hemorrhage

“…A significant negative correlation is seen between fibrinogen and D-dimer levels in late twin gestation, in which an exaggerated coagulation response has been suggested [19] based on the finding that D-dimer level is significantly higher and fibrinogen is significantly lower in late twin gestation than in late singleton gestation [18,19]. In addition, a low fibrinogen level at the initial phase of PPH increases the risk of severe PPH [9,10], and low antenatal fibrinogen level increases the risk of PPH [20,21], as was confirmed in this study. Thus, as the increase in D-dimer may have reflected enhanced fibrinolysis, i.e.…”

Management of post‐partum haemorrhage

“…Thus, fibrinogen is critical not only for clot strength but also to accelerate clot initiation and propagation 36 . However, both in the study by Charbit et al 25 with 128 women and the other study by Simon et al 35 with 797 women, the large variation in fibrinogen levels hampers the interpretation regarding when to start fibrinogen treatment during the early stages of PPH. An early determination of fibrinogen is helpful to guide the replacement therapy.…”

“…Simple routine laboratory tests to guide the replacement therapy should be urgently available. At the time of delivery, the mean fibrinogen concentration in 797 labouring women was 4.8 g/l but the range was particularly wide, 2.1–9.0 g/l 35 . Charbit et al 25 recently showed that fibrinogen at the time of diagnosis of PPH can be used to guide the management of PPH.…”