The role of decreased fibrinogen percentage in prediction of severity of postpartum haemorrhage

M. Signaroldi,F. Cirillo,P.Mustoni, G.Loi,T. Stampalija,

E. Ferrazzi A.Ragusa

Dept Obstet Gynecol, Buzzi Children’s Hospital,

University Department of Clinical Sciences, University of Milan

Global Congress of Maternal and Infant Health Barcelona 2010

Clinical retrospective study(delivery ward register 1/01/2009-31/08/2010)

5908 deliveries

PPH ≥ 2000 ml 19 cases ( 3‰)

16 included

3 excluded

Group APatients with a major complication

( hysterectomy, haemostaic surgery, blood/plasma trasfusion..)

9 cases

Group BPatients with minor

complications ( medical treatment, curettage..)

7 cases

Study design

Global Congress of Maternal and Infant Health Barcelona 2010

Results (3) (comparison between group A and B with Mann-Whitney test)

gruppo CC p. e. cc

riduzione % PROM EPH PLACENTA RCU sulpr PIU TRASF. ISTER. UTI ALTRO

A 4908 2500 83 X no no no x no X X UTI B-LYNCH

A 5164 4200 74 no no no X X X X 7 EC, 3 PFC X UTI

A 2517 4600 62 no noN.I. ACCRETA X x X X 2plasma X UTI

A 9043 3500 56 no noPPC ACCRETA no no x X ok no

A 14500 2000 52 no noPPC ACCRETA no x no X 1emazie no OK no

A 16601 3000 50 X no no X XX 3plasma, 2emazie no OK

A 3916 2000 48 X X no no no X X UTI

B-LYNCH,ematoma legamento largo, 2° LPT

A13220/1488

8 2100 47 no no no si no X 2emazie no UTIRCU, tamponamento, legatura uterine a 22gg

A 11886 2500 17 no noPPC ACCRETA no no

X 2plasma, 3emazie no OK

PERDITA EMATICA MEDIA

2933,333 3 4 3 8 5 5

gruppo CC p. e. cc

riduzione % PROM EPH PLACENTA RCU sulpr PIU TRASF. ISTER. UTI ALTRO

B 15282 2300 43 no no no no no no no OK no

B 14554 2000 34 no no no no x no no no OK no

B 1598 2100 30 X no no X no no no

B 16003 2000 27 no no no no x no no no OK no

B 13844 2000 20 no no no X x no no no OK no

B 1368 2500 18 X no no no no no

B 9660 2000 13 no no no X no no no OK s. di Asherman

PERDITA EMATICA MEDIA

2128,571 2 4 0 0 0 0

Conclusions 1) The prognosis and outcomes of PPH are more severe if

fibrinogen percentage, before and after delivery, decreased is higher than 50%.

2) PPH pathogenesis Hypothesis

First phase • Hypovolemia →Shock

Second phase •Endothelial damage → DIC

Fibrinogen Serial coagulation tests (every 1 hour)

Thromboelastometry can guide the medical intervention

3) Clinical practice