The Association of Serum Fibrinogen Levels With the Severity of Primary Postpartum Hemorrhage: A Prospective Study.

Introduction: Postpartum hemorrhage (PPH) remains a major cause of maternal mortality and morbidity worldwide. Coagulation disorders are a major risk factor for PPH that have not been studied adequately. Fibrinogen, a plasma glycoprotein, is integral to hemostasis and is involved in the final process of the coagulation cascade. Fibrinogen levels increase with advancing pregnancy probably because of an increase in estrogen levels and reach a peak (~5g/L) in the third trimester of pregnancy. However, in the postpartum period, the fibrinogen concentration shows a decreasing trend.

Objective: The purpose of the study was to study the serum fibrinogen level in patients with PPH and to find its association with the severity of primary postpartum hemorrhage.  Methodology: Patients were selected according to inclusion and exclusion criteria. Written and informed consents were taken. Routine investigations were done on admission and special investigations like red blood cell count, prothrombin time, international normalized ratio, activated partial thromboplastin time, and serum fibrinogen were done later when the patient developed PPH. Serial samples of all PPH patients for serum fibrinogen levels at 0, 1, 2, 4, and 24 hours were taken to study the serum fibrinogen levels and data were analyzed.  Result: The mean fibrinogen level on admission was 3.92 ± 0.92 g/l in non-severe PPH and 2.03 ± 0.97 g/l in the severe PPH group. Fibrinogen levels in the non-severe group remained < 4.46 g/l at 0, 1, 2, 4, and 24 hours. In the severe group, fibrinogen levels were < 2.89 g/l at 0, 1, 2, and 4 hours and it was 2.44 ± 1.06 g/l in the 24-hour samples. Statistical significance was found in all the fibrinogen values among the two study groups (p = 0.001).

Conclusion: Our results showed that zero-hour fibrinogen levels correlate significantly with the aggravation of PPH and levels <2 g/L can serve as a predictor for progression to severe PPH.