The value of fibrinogen combined with D-dimer and neonatal weight in predicting postpartum hemorrhage in vaginal delivery
-
Yanke Zou
,
Shuai Zeng
,
Changxiao Huang
Abstract
Objectives
The purpose of this study was to explore whether fibrinogen (Fib) can be used as a predictor of postpartum hemorrhage (PPH) in parturients with vaginal delivery, and the value of combining Fib with other indexes to predict postpartum hemorrhage in vaginal delivery.
Methods
A total of 207 parturients who delivered via vagina were divided into PPH group (n=102) and non-PPH group (n=105). The PPH group was further divided into mild PPH group and severe PPH group. The differences of Fib, platelet (PLT), mean platelet volume (MPV), platelet distribution width (PDW), D-dimer (D-D), hemoglobin (HGB) and neonatal weight (Nw) between the two groups were compared to explore the significance of these indexes in predicting PPH.
Results
Fib, PLT and PDW in PPH group were significantly lower than those in non-PPH group, while D-D and Nw in PPH group were significantly higher than those in non-PPH group. In the binary logistic regression model, we found that Fib, D-D and Nw were independently related to PPH. The risk of PPH increased by 9.87 times for every 1 g/L decrease in Fib. The cut-off value of Fib is 4.395 (sensitivity 0.705, specificity 0.922). The AUC value of PPH predicted by Fib combined with D-D and Nw was significantly higher than that of PPH predicted by Fib (p<0.05, 95 % CI 0.00313–0.0587).
Conclusions
Fib, D-D and Nw have good predictive value for PPH of vaginal delivery, among which Fib is the best. The combination of three indexes of Fib, D-D and Nw can predict PPH more systematically and comprehensively, and provide a basis for clinical prevention and treatment of PPH.
-
Research ethics: The research related to human use has complied with all the relevant nationaregulations, institutional policies, and in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional Review Board or equivalent committee (Ethics Committee of Army Medical Center of PLA, No. 23-01(2020)).
-
Informed consent: Not applicable.
-
Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.
-
Competing interests: The authors state no conflict of interest.
-
Research funding: None declared.
-
Data availability: The raw data can be obtained on request from the corresponding author.
References
1. Dahlke, JD, Mendez-Figueroa, H, Maggio, L, Hauspurg, AK, Sperling, JD, Chauhan, SP, et al.. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol 2015;213:71–6. https://doi.org/10.1016/j.ajog.2015.02.023.Suche in Google Scholar PubMed
2. Bienstock, JL, Eke, AC, Hueppchen, NA. Postpartum hemorrhage. N Engl J Med 2021;384:1635–45. https://doi.org/10.1056/nejmra1513247.Suche in Google Scholar PubMed PubMed Central
3. World Health Organization. WHO study shows drug could save thousands of women’s lives. Geneva: WHO; 2018.Suche in Google Scholar
4. Evensen, A, Anderson, JM, Fontaine, P. Postpartum hemorrhage: prevention and treatment. Am Fam Physician 2017;95:442–9.Suche in Google Scholar
5. Gonzalez-Brown, V, Schneider, P. Prevention of postpartum hemorrhage. Semin Fetal Neonatal Med 2020;25:101129. https://doi.org/10.1016/j.siny.2020.101129.Suche in Google Scholar PubMed
6. Kawakita, T, Mokhtari, N, Huang, JC, Landy, HJ. Evaluation of risk-assessment tools for severe postpartum hemorrhage in women undergoing cesarean delivery. Obstet Gynecol 2019;134:1308–16. https://doi.org/10.1097/aog.0000000000003574.Suche in Google Scholar PubMed
7. Dilla, AJ, Waters, JH, Yazer, MH. Clinical validation of risk stratification criteria for peripartum hemorrhage. Obstet Gynecol 2013;122:120–6. https://doi.org/10.1097/aog.0b013e3182941c78.Suche in Google Scholar PubMed
8. Venkatesh, KK, Strauss, RA, Grotegut, CA, Heine, RP, Chescheir, NC, Stringer, J, et al.. Machine learning and statistical models to predict postpartum hemorrhage. Obstet Gynecol 2020;135:935–44. https://doi.org/10.1097/aog.0000000000003759.Suche in Google Scholar PubMed PubMed Central
9. Ruppel, H, Liu, VX, Gupta, NR, Soltesz, L, Escobar, GJ. Validation of postpartum hemorrhage admission risk factor stratification in a large obstetrics population. Am J Perinatol 2021;38:1192–200. https://doi.org/10.1055/s-0040-1712166.Suche in Google Scholar PubMed PubMed Central
10. Butwick, AJ. Postpartum hemorrhage and low fibrinogen levels: the past, present and future. Int J Obstet Anesth 2013;22:87–91. https://doi.org/10.1016/j.ijoa.2013.01.002.Suche in Google Scholar PubMed
11. Clark, V, Fernando, R, Van de Velde, M. Oxford textbook of obstetric anaesthesia, 1st ed. New York, U.S.A.: OUP Oxford; 2016.10.1093/med/9780198713333.001.0001Suche in Google Scholar
12. Thornton, P, Douglas, J. Coagulation in pregnancy. Best Pract Res Clin Obstet Gynaecol 2010;24:339–52. https://doi.org/10.1016/j.bpobgyn.2009.11.010.Suche in Google Scholar PubMed
13. Charbit, B, Mandelbrot, L, Samain, E, Baron, G, Haddaoui, B, Keita, H, et al.. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage. J Thromb Haemostasis 2007;5:266–73. https://doi.org/10.1111/j.1538-7836.2007.02297.x.Suche in Google Scholar PubMed
14. Okada, A, Okada, Y, Inoue, M, Narumiya, H, Nakamoto, O. Lactate and fibrinogen as good predictors of massive transfusion in postpartum hemorrhage. Acute Med Surg 2020;7:e453. https://doi.org/10.1002/ams2.453.Suche in Google Scholar PubMed PubMed Central
15. Kaufner, L, Henkelmann, A, von Heymann, C, Feldheiser, A, Mickley, L, Niepraschk-von, DK, et al.. Can prepartum thromboelastometry-derived parameters and fibrinogen levels really predict postpartum hemorrhage?. J Perinat Med 2017;45:427–35. https://doi.org/10.1515/jpm-2016-0009.Suche in Google Scholar PubMed
16. Biguzzi, E, Franchi, F, Ambrogi, F, Ibrahim, B, Bucciarelli, P, Acaia, B, et al.. Risk factors for postpartum hemorrhage in a cohort of 6011 Italian women. Thromb Res 2012;129:e1–7. https://doi.org/10.1016/j.thromres.2011.09.010.Suche in Google Scholar PubMed
17. Orita, Y, Hamada, T, Togami, S, Douchi, T, Kobayashi, H. The optimal cutoff level of D-dimer during pregnancy to exclude deep vein thrombosis, and the association between D-dimer and postpartum hemorrhage in cesarean section patients. Kurume Med J 2021;66:107–14. https://doi.org/10.2739/kurumemedj.ms662003.Suche in Google Scholar
18. Ozturk, E, Yildirim, KS, Ince, O, Karaca, I. Can prepartum platelet indices be a parameter to predict postpartum hemorrhage?. J Matern Fetal Neonatal Med 2022;35:2829–35. https://doi.org/10.1080/14767058.2020.1803261.Suche in Google Scholar PubMed
19. Gortner, L, Pohlandt, F. Central venous air embolism in an artificially respirated premature infant with respiratory distress syndrome. Klin Pädiatr 1984;196:385–7. https://doi.org/10.1055/s-2008-1034102.Suche in Google Scholar PubMed
20. Su, CW. Postpartum hemorrhage. Prim Care Clin Off Pract 2012;39:167–87. https://doi.org/10.1016/j.pop.2011.11.009.Suche in Google Scholar PubMed
21. Cooper, N, O’Brien, S, Siassakos, D. Training health workers to prevent and manage post-partum haemorrhage (PPH). Best Pract Res Clin Obstet Gynaecol 2019;61:121–9. https://doi.org/10.1016/j.bpobgyn.2019.05.008.Suche in Google Scholar PubMed
22. Neary, C, Naheed, S, McLernon, DJ, Black, M. Predicting risk of postpartum haemorrhage: a systematic review. BJOG 2021;128:46–53. https://doi.org/10.1111/1471-0528.16379.Suche in Google Scholar PubMed
23. Andrikopoulou, M, D’Alton, ME. Postpartum hemorrhage: early identification challenges. Semin Perinatol 2019;43:11–7. https://doi.org/10.1053/j.semperi.2018.11.003.Suche in Google Scholar PubMed
24. Cortet, M, Deneux-Tharaux, C, Dupont, C, Colin, C, Rudigoz, RC, Bouvier-Colle, MH, et al.. Association between fibrinogen level and severity of postpartum haemorrhage: secondary analysis of a prospective trial. Br J Anaesth 2012;108:984–9. https://doi.org/10.1093/bja/aes096.Suche in Google Scholar PubMed
25. Lang, T, Johanning, K, Metzler, H, Piepenbrock, S, Solomon, C, Rahe-Meyer, N, et al.. The effects of fibrinogen levels on thromboelastometric variables in the presence of thrombocytopenia. Anesth Analg 2009;108:751–8. https://doi.org/10.1213/ane.0b013e3181966675.Suche in Google Scholar PubMed
26. Morrow, GB, Carlier, MSA, Dasgupta, S, Craigen, FB, Mutch, NJ, Curry, N. Fibrinogen replacement therapy for traumatic coagulopathy: does the fibrinogen source matter? Int J Mol Sci 2021;22:2185. https://doi.org/10.3390/ijms22042185.Suche in Google Scholar PubMed PubMed Central
27. Geddings, J, Mackman, N. New players in haemostasis and thrombosis. Thromb Haemostasis 2017;111:570–4. https://doi.org/10.1160/th13-10-0812.Suche in Google Scholar PubMed PubMed Central
28. Kearney, KJ, Ariens, R, Macrae, FL. The role of fibrin(ogen) in wound healing and infection control. Semin Thromb Hemost 2022;48:174–87. https://doi.org/10.1055/s-0041-1732467.Suche in Google Scholar PubMed
29. Seltana, A, Cloutier, G, Reyes, NV, Khalfaoui, T, Teller, IC, Perreault, N, et al.. Fibrin(ogen) is constitutively expressed by differentiated intestinal epithelial cells and mediates wound healing. Front Immunol 2022;13:916187. https://doi.org/10.3389/fimmu.2022.916187.Suche in Google Scholar PubMed PubMed Central
30. Maher, GM, McKernan, J, O’Byrne, L, Corcoran, P, Greene, RA, Khashan, AS, et al.. Predicting risk of postpartum haemorrhage during the intrapartum period in a general obstetric population. Eur J Obstet Gynecol Reprod Biol 2022;276:168–73. https://doi.org/10.1016/j.ejogrb.2022.07.024.Suche in Google Scholar PubMed
31. Liu, J, Wang, C, Yan, R, Lu, Y, Bai, J, Wang, H, et al.. Machine learning-based prediction of postpartum hemorrhage after vaginal delivery: combining bleeding high risk factors and uterine contraction curve. Arch Gynecol Obstet 2022;306:1015–25. https://doi.org/10.1007/s00404-021-06377-0.Suche in Google Scholar PubMed
32. Royal College of Obstetricians and Gynaecologists. Prevention and management of postpartum haemorrhage. BJOG An Int J Obstet Gynaecol 2017;124:e106–49.Suche in Google Scholar
33. Manten, GT, Franx, A, Sikkema, JM, Hameeteman, TM, Visser, GH, de Groot, PG, et al.. Fibrinogen and high molecular weight fibrinogen during and after normal pregnancy. Thromb Res 2004;114:19–23. https://doi.org/10.1016/j.thromres.2004.04.008.Suche in Google Scholar PubMed
34. Skornova, I, Simurda, T, Stasko, J, Horvath, D, Zolkova, J, Holly, P, et al.. Use of fibrinogen determination methods in differential diagnosis of hypofibrinogenemia and dysfibrinogenemia. Clin Lab 2021;67. https://doi.org/10.7754/clin.lab.2020.200820.Suche in Google Scholar
© 2024 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Review
- Outcome of fetal congenital pulmonary malformations: a systematic review and meta-analysis
- Original Articles – Obstetrics
- Reducing decisional conflict in decisions about prenatal genetic testing: the impact of a dyadic intervention at the start of prenatal care
- The value of fibrinogen combined with D-dimer and neonatal weight in predicting postpartum hemorrhage in vaginal delivery
- Current obstetric outcomes in Jamaican women with sickle hemoglobinopathy – a balance of risks for aspirin?
- Does delayed cord clamping result in higher maternal blood loss in primary cesarean sections? A retrospective comparative study
- Trends in antenatal corticosteroid administration: did our timing improve?
- A national survey on current practice of ultrasound in labor ward
- Understanding current antenatal Hepatitis C testing and care in maternity services in England
- Exploring the clinical utility of exome sequencing/Mono, Duo, Trio in prenatal testing: a retrospective study in a tertiary care centre in South India
- Original Articles – Fetus
- Fetoscopic laser coagulation for twin-to-twin transfusion syndrome: a comparison of flexible 1.0/1.2 mm fetoscopes with curved sheaths of 2.7/3.3 mm2 vs. 2 mm fetoscopic lens technique with sheaths of 6.6/11.3 mm2
- Value of fetal echocardiographic examination in pregnancies complicated by preterm premature rupture of membranes
- Bias in the prenatal lung measurements in fetal congenital diaphragmatic hernia with intrauterine growth restriction
- Original Articles – Neonates
- Chest radiographic thoracic areas and respiratory outcomes in infants with anterior abdominal wall defects
- Temporal effects of caffeine on intrapulmonary shunt in preterm ventilated infants
- Letter to the Editor
- HDlive Silhouette features of physiological midgut herniation
Artikel in diesem Heft
- Frontmatter
- Review
- Outcome of fetal congenital pulmonary malformations: a systematic review and meta-analysis
- Original Articles – Obstetrics
- Reducing decisional conflict in decisions about prenatal genetic testing: the impact of a dyadic intervention at the start of prenatal care
- The value of fibrinogen combined with D-dimer and neonatal weight in predicting postpartum hemorrhage in vaginal delivery
- Current obstetric outcomes in Jamaican women with sickle hemoglobinopathy – a balance of risks for aspirin?
- Does delayed cord clamping result in higher maternal blood loss in primary cesarean sections? A retrospective comparative study
- Trends in antenatal corticosteroid administration: did our timing improve?
- A national survey on current practice of ultrasound in labor ward
- Understanding current antenatal Hepatitis C testing and care in maternity services in England
- Exploring the clinical utility of exome sequencing/Mono, Duo, Trio in prenatal testing: a retrospective study in a tertiary care centre in South India
- Original Articles – Fetus
- Fetoscopic laser coagulation for twin-to-twin transfusion syndrome: a comparison of flexible 1.0/1.2 mm fetoscopes with curved sheaths of 2.7/3.3 mm2 vs. 2 mm fetoscopic lens technique with sheaths of 6.6/11.3 mm2
- Value of fetal echocardiographic examination in pregnancies complicated by preterm premature rupture of membranes
- Bias in the prenatal lung measurements in fetal congenital diaphragmatic hernia with intrauterine growth restriction
- Original Articles – Neonates
- Chest radiographic thoracic areas and respiratory outcomes in infants with anterior abdominal wall defects
- Temporal effects of caffeine on intrapulmonary shunt in preterm ventilated infants
- Letter to the Editor
- HDlive Silhouette features of physiological midgut herniation
