Hemostasis as a Risk Factor for Refractory Postpartum Hemorrhage
N. V. Artymuk,
T. Yu. Marochko,
D. A. Artymuk,
S. V. Apresyan,
N. B. Kolesnikova,
A. V. Atalyan,
N. M. Shibelgut,
N. A. Batina https://doi.org/10.31550/1727-2378-2024-23-5-43-49
Abstract
Aim. To conduct a comparative assessment of the main parameters of hemostasis before delivery in patients with refractory postpartum hemorrhage (PPH) and without PPH.
Design. A retrospective case — control study (copy — pair 1 : 3).
Materials and methods. The study included 55 patients with refractory PPH (main group) and 165 women without PPH (control group). The level of hemoglobin, platelets and hematocrit were determined on a hematology analyzer Mindray BC-6800 Plus based on SF Cube technology, the level of fibrinogen and activated partial thromboplastin time — on an automatic hemostasis analyzer SYSMEX CS-1600 based on multiwave analysis technology. The volume of blood loss was estimated gravimetrically. The obtained data were analyzed and visualized using the Python programming language version 3 and the pandas, scipy.stats, matplotlib.pyplot libraries.
Results. Blood loss during delivery in the main group was significantly higher than in the control group and amounted to 1478.18 (679.78) and 462.12 (209.32) ml, respectively (p < 0.001). The fibrinogen level before delivery in women with refractory PPH was statistically significantly lower compared to the control group: 3.9 (3.3; 4.5) and 4.4 (3.9; 4.96) g/l, respectively (p = 0.002). Other hemostasis parameters did not have statistically significant differences between the groups.
Conclusion. In patients with refractory PPH, the fibrinogen level was statistically significantly lower than in women without this complication. A fibrinogen level of less than 3.95 g/L may be a predictor of refractory PPH (AUC 95% CI: 0.65 (0.55; 0.75)).
About the Authors
N. V. Artymuk
Kemerovo State Medical University
Russian Federation
Russian Federation
22A Voroshilova Str., Kemerovo, 650056
T. Yu. Marochko
Kemerovo State Medical University
Russian Federation
Russian Federation
22A Voroshilova Str., Kemerovo, 650056
D. A. Artymuk
Peoples' Friendship University of Russia named after Patrice Lumumba
Russian Federation
Russian Federation
6 Miklukho-Maklay Str., Moscow, 117198
S. V. Apresyan
Peoples' Friendship University of Russia named after Patrice Lumumba
Russian Federation
Russian Federation
6 Miklukho-Maklay Str., Moscow, 117198
N. B. Kolesnikova
Kemerovo State Medical University
Russian Federation
Russian Federation
22A Voroshilova Str., Kemerovo, 650056
A. V. Atalyan
Scientific Center for Family Health and Human Reproduction Problems
Russian Federation
Russian Federation
16 Timiryazeva Str., Irkutsk, 664003
N. M. Shibelgut
Kuzbass Regional Clinical Hospital named after S.V. Belyaev
Russian Federation
Russian Federation
22 Oktyabrsky Ave., Kemerovo, 650066
N. A. Batina
Kuzbass Regional Clinical Hospital named after S.V. Belyaev
Russian Federation
Russian Federation
22 Oktyabrsky Ave., Kemerovo, 650066
References
1. Liu L.Y., Nathan L., Sheen J.J., Goffman D. Review of current insights and therapeutic approaches for the treatment of refractory postpartum hemorrhage. Int. J. Womens Health. 2023;15:905–26. DOI: 10.2147/IJWH.S366675
2. Anger H.A., Dabash R., Durocher J., Hassanein N. et al. The effectiveness and safety of introducing condom-catheter uterine balloon tamponade for postpartum haemorrhage at secondary level hospitals in Uganda, Egypt and Senegal: a stepped wedge, cluster-randomised trial. BJOG. 2019;126(13):1612–21. DOI: 10.1111/1471-0528.15903
3. Rozenberg P., Sentilhes L., Goffinet F., Vayssiere C. et al. Efficacy of early intrauterine balloon tamponade for immediate postpartum hemorrhage after vaginal delivery: a randomized clinical trial. Am. J. Obstet. Gynecol. 2023;229(5):542.e1–14. DOI: 10.1016/j.ajog.2023.05.014
4. Cebekhulu S.N., Abdul H., Batting J., Chauke L. et al. "Suction Tube Uterine Tamponade" for treatment of refractory postpartum hemorrhage: internal feasibility and acceptability pilot of a randomized clinical trial. Int. J. Gynaecol. Obstet. 2022;158(1): 79–85. DOI: 10.1002/ijgo.13963
5. Lavigne-Lissalde G., Aya A.G., Mercier F.J., Roger-Christoph S. et al. Recombinant human FVIIa for reducing the need for invasive second-line therapies in severe refractory postpartum hemorrhage: a multicenter, randomized, open controlled trial. J. Thromb. Haemost. 2015;13(4):520–9. DOI: 10.1111/jth.12844
6. Liu Z., Wang Y., Yan J., Li J. et al. Uterine artery embolization versus hysterectomy in the treatment of refractory postpartum hemorrhage: a systematic review and meta-analysis. J. Matern. Fetal Neonatal Med. 2020;33(4):693–705. DOI: 10.1080/14767058.2018.1497599
7. Zhang Y., Yan J., Han Q., Yang T. et al. Emergency obstetric hysterectomy for life-threatening postpartum hemorrhage: a 12-year review. Medicine (Baltimore). 2017;96(45):e8443. DOI: 10.1097/MD.0000000000008443
8. Gilmandyar D., Thornburg L.L. Surgical management of postpartum hemorrhage. Semin. Perinatol. 2019;43(1):27–34. DOI: 10.1053/j.semperi.2018.11.006
9. Okunlola O., Raza S., Osasan S., Sethia S. et al. Race/ethnicity as a risk factor in the development of postpartum hemorrhage: a thorough systematic review of disparity in the relationship between pregnancy and the rate of postpartum hemorrhage. Cureus. 2022;14(6):e26460. DOI: 10.7759/cureus.26460
10. Nigussie J., Girma B., Molla A., Tamir T. et al. Magnitude of postpartum hemorrhage and its associated factors in Ethiopia: a systematic review and meta-analysis. Reprod. Health. 2022;19(1):63. DOI: 10.1186/s12978-022-01360-7
11. Wang C., Zhang C. Meta-analysis to assess the role of maternal characteristics and risk factors on postpartum hemorrhage. Adv. Clin. Exp. Med. 2023;32(7):723–31. DOI: 10.17219/acem/158474
12. Ende H.B., Lozada M.J., Chestnut D.H., Osmundson S.S. et al. Risk factors for atonic postpartum hemorrhage: a systematic review and meta-analysis. Obstet. Gynecol. 2021;137(2):305–23. DOI: 10.1097/AOG.0000000000004228
13. Omotayo M.O., Abioye A.I., Kuyebi M., Eke A.C. Prenatal anemia and postpartum hemorrhage risk: a systematic review and metaanalysis. J. Obstet. Gynaecol. Res. 2021;47(8):2565–76. DOI: 10.1111/jog.14834
14. Jung J., Rahman M.M., Rahman M.S., Swe K.T. et al. Effects of hemoglobin levels during pregnancy on adverse maternal and infant outcomes: a systematic review and meta-analysis. Ann. N. Y. Acad. Sci. 2019;1450(1):69–82. DOI: 10.1111/nyas.14112
15. Artymuk N.V., Marochko T.Yu., Apresyan S.V., Artymuk D.A. et al. Frequency of occurrence, main risk factors and effectiveness of treatment of patients with postpartum hemorrhage. Doctor.Ru. 2023;22(5):14–9. (in Russian). DOI: 10.31550/1727-2378-2023-22-5-14-19
16. De Moreuil C., Mehic D., Nopp S., Kraemmer D. et al. Hemostatic biomarkers associated with postpartum hemorrhage: a systematic review and meta-analysis. Blood Adv. 2023;7(19):5954–67. DOI: 10.1182/bloodadvances.2023010143
17. Gayat E., Resche-Rigon M., Morel O., Rossignol M. et al. Predictive factors of advanced interventional procedures in a multicentre severe postpartum haemorrhage study. Intensive Care Med. 2011;37(11):1816–25. DOI: 10.1007/s00134-011-2315-0
18. Cortet M., Deneux-Tharaux C., Dupont C., Colin C. et al. Association between fibrinogen level and severity of postpartum haemorrhage:secondary analysis of a prospective trial. Br. J. Anaesth. 2012;108:984–9. DOI: 10.1093/bja/aes096
19. Yilmaz E.P.T., Celik Y., Topdagi Y.E., Guzel A.I. et al. New approach to the risk variables for administration of fibrinogen in patients with postpartum hemorrhage by using cluster analysis. Int. J. Gynaecol. Obstet. 2021;152(2):256–61. DOI: 10.1002/ijgo.13386
20. Gonzalez-Brown V., Schneider P. Prevention of postpartum hemorrhage. Semin. Fetal Neonatal. Med. 2020;25(5):101129. DOI: 10.1016/j.siny.2020.101129
21. Artymuk D.A., Apresyan S.V., Artymuk N.V., Marochko T.Yu. et al. An integrated approach to the prevention of postpartum bleeding in high-risk patients. Fundamental and Clinical Medicine. 2024;9(2):55–65. (in Russian). DOI: 10.23946/2500-0764-2024-9- 2-55-65
22. Lautredou M., Pan-Petesch B., Dupré P.F., Drugmanne G. et al. Excessive gestational weight gain is an independent risk factor for gestational diabetes mellitus in singleton pregnancies: results from a French cohort study. Eur. J. Obstet. Gynecol. Reprod. Biol. 2022;275:31–6. DOI: 10.1016/j.ejogrb.2022.06.009
23. Qi S., Fu X. Establishment of a predictive model for postpartum hemorrhage in twins: a retrospective study. BMC Pregnancy Childbirth. 2023;23(1):644. DOI: 10.1186/s12884-023-05933-7
24. Salomon C., de Moreuil C., Hannigsberg J., Trémouilhac C. et al. Haematological parameters associated with postpartum haemorrhage after vaginal delivery: results from a French cohort study. J. Gynecol. Obstet. Hum. Reprod. 2021;50(9):102168. DOI: 10.1016/j.jogoh.2021.102168
25. Wikkelsø A.J., Edwards H.M., Afshari A., Stensballe J. et al. Preemptive treatment with fibrinogen concentrate for postpartum haemorrhage: randomized controlled trial. Br. J. Anaesth. 2015;114(4):623–33. DOI: 10.1093/bja/aeu444
Review
For citations:
Artymuk N.V., Marochko T.Yu., Artymuk D.A., Apresyan S.V., Kolesnikova N.B., Atalyan A.V., Shibelgut N.M., Batina N.A. Hemostasis as a Risk Factor for Refractory Postpartum Hemorrhage. Title. 2024;23(5):43-49. (In Russ.) https://doi.org/10.31550/1727-2378-2024-23-5-43-49
Views:
55
Email this article 