The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage
The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage
复制标题
DOI：
10.1111/j.1538-7836.2007.02297.x
复制
发表时间：
2007-02-01
影响因子：
10.4
通讯作者：
De Prost, D.
中科院分区：
文献类型：
--
作者：
Charbit, B.;Mandelbrot, L.;De Prost, D.
背景：产后出血（PPH）是孕产妇发病的主要原因。目的：本研究的目的是确定PPH过程中止血标志物的变化是否可预测其严重程度。患者和方法：我们招募了128名需要子宫收缩性前列腺素E2（硫前列酮）输注的PPH妇女。根据最初24小时内的结局将PPH分为两组（重度和非重度PPH）。根据我们的标准，128名妇女中有50名患有严重的PPH。在入组时（H 0）以及入组后1、2、4和24小时进行系列凝血试验。结果如下：在H 0和H4，与非重度PPH患者相比，重度PPH患者的纤维蛋白原、因子V、抗凝血酶活性、蛋白C抗原、凝血酶原时间延长、D-二聚体和达特复合物显著降低。在多因素分析中，从H 0到H4，纤维蛋白原是唯一与重度PPH发生相关的标志物。在H 0时，纤维蛋白原每减少1 gL（-1），重度PPH的风险增加2.63倍。纤维蛋白原浓度> 4 gL（-1）的阴性预测值为79%，
Background: Postpartum hemorrhage (PPH) is a major source of maternal morbidity. Objectives: This study's objective was to determine whether changes in hemostasis markers during the course of PPH are predictive of its severity. Patients and methods: We enrolled 128 women with PPH requiring uterotonic prostaglandin E2 (sulprostone) infusion. Two groups were defined (severe and non-severe PPH) according to the outcome during the first 24 hours. According to our criteria, 50 of the 128 women had severe PPH. Serial coagulation tests were performed at enrollment (H0), and 1, 2, 4 and 24 hours thereafter. Results: At H0, and through H4, women with severe PPH had significantly lower fibrinogen, factor V, antithrombin activity, protein C antigen, prolonged prothrombin time, and higher D-dimer and TAT complexes than women with non-severe PPH. In multivariate analysis, from H0 to H4, fibrinogen was the only marker associated with the occurence of severe PPH. At H0, the risk for severe PPH was 2.63-fold higher for each 1 gL(-1) decrease of fibrinogen. The negative predictive value of a fibrinogen concentration > 4 gL(-1) was 79% and the positive predictive value of a concentration