Pre‐delivery fibrinogen predicts adverse maternal or neonatal outcomes in patients with placental abruption

Abstract

Aim: Placental abruption is a severe obstetric complication of pregnancy that can cause disseminated intravascular coagulation and progress to massive post-partum hemorrhage. Coagulation disorder due to extreme consumption of fibrinogen is considered the main pathogenesis of disseminated intravascular coagulation in patients with placental abruption. The present study sought to determine if the pre-delivery fibrinogen level could predict adverse maternal or neonatal outcomes in patients with placental abruption. Methods: This retrospective medical chart review was conducted in a center for maternal, fetal, and neonatal medicine in Japan with 61 patients with placental abruption. Fibrinogen levels prior to delivery were collected and evaluated for the prediction of maternal and neonatal outcomes. The main outcome measures for maternal outcomes were disseminated intravascular coagulation and hemorrhage, and the main outcome measures for neonatal outcomes were Apgar score at 5 min, umbilical artery pH, and stillbirth. Results: The receiver-operator curve and multivariate logistic regression analyses indicated that fibrinogen significantly predicted overt disseminated intravascular coagulation and the requirement of ≥6 red blood cell units, ≥10 fresh frozen plasma units, and ≥20 fresh frozen plasma units for transfusion. Moderate hemorrhage occurred in 71.5% of patients with a decrease in fibrinogen levels to 155 mg/dL. Fibrinogen could also predict neonatal outcomes. Umbilical artery pH < 7.00 occurred in 77.1% of patients with a decrease in fibrinogen levels to ≤ 250 mg/dL. Conclusion: Pre-delivery fibrinogen can predict adverse maternal as well as neonatal outcomes with placental abruption.

The Clinical Efficacy of Fibrinogen Concentrate in Massive Obstetric Haemorrhage with Hypofibrinogenaemia

“…The present study suggests that the use of fibrinogen concentrate would be particularly effective for massive obstetric haemorrhage, although recent data relating to non-obstetric haemorrhage show no benefits for fibrinogen concentrate administration19. This may be because pregnancy enhances coagulation and reduces fibrinolysis2021, which affects consumption of fibrinogen and hyperfibrinolysis in cases of massive obstetrical haemorrhage. In addition, the use of fibrinogen concentrate and FFP is the usual treatment method in many countries.…”

“…Consequently, rapid fibrinogen supplementation immediately improves coagulopathy and achieves haemostasis. Therefore, as shown in Table 4, the use of fibrinogen concentrate would be very beneficial in the early stages of consumption coagulopathy caused by placental abruption because it would minimise blood loss and transfusion volume2127.…”

Fibrinogen for the management of critical obstetric hemorrhage

“…In COH, coagulopathy easily develops due to the physiological change of blood coagulation and fibrinolytic function in pregnant women during late pregnancy, and it is difficult to evaluate the severity due to the volume of blood loss . Blood fibrinogen concentration has been suggested as an indicator of its severity …”

Rupture of hidden abnormal myometrial vessels during cesarean delivery of a patient with subserosal leiomyoma: A possible pathogenesis of sudden‐onset disseminated intravascular coagulation

“…We believe this was because the ruptured dilated veins due to the myometrial sectioning were exposed to amniotic fluid, resulting in a DIC type of amniotic fluid embolism, although there were no severe cardiopulmonary symptoms involved in this case. Previous studies indicated that fibrinogen levels <87 mg/dL were associated with a very high rate (95.2%) of DIC requiring massive transfusions . Therefore, the extremely low fibrinogen levels found in similar cases might be a key signal indicating the need for prompt transfusion and surgical treatment.…”

“…Previous studies indicated that fibrinogen levels <87 mg/dL were associated with a very high rate (95.2%) of DIC requiring massive transfusions. 7 Therefore, the extremely low fibrinogen levels found in similar cases might be a key signal indicating the need for prompt transfusion and surgical treatment. Uterine artery embolization might be an option for treating obstetric hemorrhage.…”