Hemostatic profile in patients with and without postpartum hemorrhage
Keywords:
Postpartum Hemorrhage, Prothrombin Time, Platelet Count, Fibrinogen, Activated Partial Thromboplastin TimeAbstract
Background: The association between coagulation profile and postpartum hemorrhage (PH) is still debated.
Objective: To determine the association between hemostatic profile and PH in women with cesarean operation (CO).
Methods: We included 92 patients with PH (cases) and 184 without (controls), patients were attended during 2014, at one hospital of the Instituto Mexicano del Seguro Social in Mérida, Yucatán. Demographic, clinical and laboratory data including prothrombin time (PT), activated partial thromboplastin time (aPTT), platelet count (PLC), and fibrinogen concentration were compared among cases and controls using a binary logistic regression model (LRM), from which odd ratios (OR), and 95% confidence intervals (95% CI), were obtained.
Results: According to the bivariate comparison, in the LRM categorical data such as parity, any type of hypertensive comorbidity, type of anesthesia, and categorized aPTT (< 38 vs. ≥ 38 seconds), and one continuous variable (gestational age) were included. Having some hypertensive comorbidity (OR 3.55, 95% CI: 1.95-6.47), type of anesthesia (regional anesthesia, OR 0.27, 95% CI: 0.13-0.55) and aPTT (< 38 seconds, OR 0.26, 95% CI: 0.10-0.66) were all statistically significant. Categorized PT, platelet count and fibrinogen concentration, were not statistically significant.
Conclusions: In this sample, having some hypertensive comorbidity increased risk of PH more than three times, while regional anesthesia and aPTT < 38 seconds reduced risk in 73% and 74%, respectively. Neither platelet count, nor fibrinogen concentration, or the PT categories modified risk of PH.
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References
Páramo J, Panizo E, Pegenaute C, Lecumberri R. Coagulación 2009: una visión moderna de la hemostasia. Rev Med Univ Navarra. 2009;53:19-23.
Jurk K, Kehrel BE. Platelets: physiology and biochemistry. Semin Thromb Hemost 2005;31: 381-92.
Holland L, Sarode R: Should plasma be transfused prophylactically before invasive procedures? Curr Opin Hematol. 2006;13:447-51.
Chee YL, Greaves M. Role of coagulation testing in predicting bleeding risk. Hematol J. 2003;4:373-8.
Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol. 2008;22:999-1012.
Lutomski JE, Byrne BM, Devane D, Greene RA. Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study. BJOG. 2012;119:306-14.
Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg. 2010;110:1368-73.
Holland LL, Brooks JP. Toward rational fresh frozen plasma transfusion. The effect of plasma transfusion on coagulation test results. Am J Clin Pathol. 2006;126:133-9.
Knight M, Callaghan WM, Berg C, Alexander S, Bouvier-Colle MH, Ford JB, et al. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy and Childbirth [Serie en internet]. 2009;9:55. Disponible en: http://www.biomedcentral.com/1471-2393/9/55
Balki M, Dhumne S, Kasodekar S, Seaward G, Carvalho JC. Blood transfusion for primary postpartum hemorrhage: a tertiary care hospital review. J Obstet Gynaecol Can. 2008;30:1002-7.
Kacmar RM, Mhyre JM, Scavone BM, Fuller AJ, Toledo P. The use of postpartum hemorrhage protocols in United States academic obstetric anesthesia units. Anesth Analg. 2014;119:906-10.
Tuzovic L, Djelmiš J, Ilijic M. Obstetric risk factors associated with placenta previa development: case-control study. Croat Med J. 2003;44:728-33.
Magann EF, Evans S, Hutchinson M, Collins R, Lanneau G, Morrison JC. Postpartum hemorrhage after cesarean delivery: an analysis of risk factors. South Med J. 2005;98:681-5.
Chang CC, Wang-T, Chen YH, Lin HC. Anesthetic management as a risk factor for postpartum hemorrhage after cesarean deliveries. Am J Obstet Gynecol. 2011;205:462e1-7.
Snegovskikha D, Clebonea A, Norwitz E. Anesthetic management of patients with placenta accreta and resuscitation strategies for associated massive hemorrhage. Curr Opin Anesthesiol. 2011;24:274-81.
Franchi F, Ibrahim B, Rossi F, Maspero ML, Morabito O, Asti D, et al. Coagulation testing before epidural analgesia at delivery: cost analysis. Thromb Res. 2011;128:18-20.
O’Riordan MN, Higgins JR. Haemostasis in normal and abnormal pregnancy. Best Pract Res Clin Obstet Gynaecol. 2003;17:385-96.
Erhabor O, Isaac IZ, Muhammad AM, Abdulrahaman Y, Ezimah AC, Adias TC. Some hemostatic parameters in women with obstetric hemorrhage in Sokoto, Nigeria. Int J Women’s Health. 2013;5:285-91.
Gayat E, Resche-Rigon M, Morel O, Rossignol M, Mantz J, Nicolas-Robin A, et al. Predictive factors of advanced interventional procedures in a multicentre severe postpartum haemorrhage study. Intensive Care Med. 2011;37:1816-25.
de Lloyd L, Bovington R, Kaye A, Collis RE, Rayment R, Sanders J, et al. Standard haemostatic tests following major obstetric haemorrhage. Int J Obstet Anesth. 2011;20:135-41.
Charbit B, Mandelbrot L, Samain E, Baron G, Haddaoui B, Keita H, et al. PPH Study Group. The decrease of fibrinogen is an early predictor of the severity of post¬partum hemorrhage. J Thromb Haemost. 2007;5:266-73.
Haas T, Fries D, Tanaka KA, Asmis L, Curry NS, Schöchl H. Coagulopathic bleeding: is there any evidence? Br J Anaesth. 2015;114:217-24.
Simon L, Santi TM, Sacquin P, Hamza J. Pre-anaesthetic assessment of coagulation abnormalities in obstetric patients: usefulness, timing and clinical implications. Br J Anaesth. 1997;78:678-83.
McCrae KR, Samuels P, Schreiber AD. Pregnancy-associated thrombocytopenia: Pathogenesis and management. Blood. 1992;80:2697.
Anteby E, Shalev O. Clinical relevance of gestational thrombocytopenia of < 100,000/microliters. Am J Hematol. 1994;47:118-22.
Thornton P, Douglas J. Coagulation in pregnancy. Best Prac Res Clin Obst Gynaecol. 2010;24:339-52.
Usta IM, Hobeika EM, Abu Musa AA, Gabriel GA, Nassar AH. Placenta previa-accreta: Risk factors and complications. Am J Obstet Gynecol. 2005;193:1045-9.
von Schmidt auf Altenstadt JF, Hukkelhoven CW, van Roosmalen J, Bloemenkamp KW. Pre-eclampsia increases the risk of postpartum haemorrhage: a nationwide cohort study in the Netherlands. PLoS One. 2013;8(12): [10 páginas]. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867333/pdf/pone.0081959.pdf
Feerasta SH, Motiei A, Motiwala S, Zuberi NF. Uterine atony at a tertiary care hospital in Pakistan: a risk factor analysis. J Pak Med Assoc. 2000;50:132-6.
Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersena B. Prevalence and risk factors of severe obstetric haemorrhage. BJOG. 2008;115:1265-72.
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