Department of Haematology and Transfusion Medicine, Usmanu Danfodio University, Sokoto, Bayelsa State, Nigeria.
Int J Womens Health. 2013 Jun 14;5:285-91. doi: 10.2147/IJWH.S43503. Print 2013.
Obstetric hemorrhage is the leading cause of maternal mortality and morbidity worldwide. This study was carried out to investigate the effect of obstetric hemorrhage on the prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet count (PLC). Women with obstetric hemorrhage were divided into two categories, women with antepartum hemorrhage (APH) and those with postpartum hemorrhage (PPH). Pregnant women without hemorrhage were included as controls. Eighty-six pregnant women aged 18-45 years (mean age 36.25 ± 10.50 years) were presented to the Obstetrics and Gynaecology Department of Maryam Abacha Women and Children Hospital in Sokoto Metropolis, Sokoto State, Nigeria with history of obstetric hemorrhage. Forty-three age-matched nonhemorrhaging parturient women were included as controls. The determination of PT and APTT was done by manual methods using commercially prepared Diagen reagent kits, whereas PLC was done by manual methods using a hemocytometer. The results of PT and APTT were significantly higher among women with APH (20.7 ± 4.226 seconds and 46.04 ± 8.689 seconds, respectively) and among women with PPH (23.17 ± 2.708 seconds and 53.78 ± 4.089 seconds, respectively) compared to normal pregnant women (15.85 ± 0.8930 seconds and 36.225 ± 5.010 seconds, respectively) (P = 0.0001). Similarly, the PLC was significantly higher among normal pregnant women compared to those with APH and PPH (291.425 ± 75.980 × 10(9) compared to 154.83 ± 47.019 × 10(9) and 136.43 ± 43.894 × 10(9), respectively) (P = 0.0001). The PT and APTT of women who presented with PPH were significantly higher compared to those who presented with APH (23.17 ± 2.708 seconds and 53.78 ± 4.089 seconds versus 20.7 ± 4.226 seconds and 46.04 ± 8.689 seconds, respectively) (P = 0.02 and P = 0.04, respectively). The PLC was significantly higher among women who presented with APH compared to those who presented with PPH (P = 0.01). The PT and APTT values were higher in the third trimester among women with APH (24.38 ± 2.33 seconds and 52.25 ± 6.71 seconds, respectively), PPH (24.75 ± 2.63 seconds and 58.25 ± 2.53 seconds, respectively), and control women (16.00 ± 0.82 seconds and 34.42 ± 5.59 seconds, respectively) compared to those in first and second trimester. The PLC was significantly lower in the third trimester among APH, PPH, and normal pregnant women (131 ± 23.02 × 10(9), 99 ± 21.46 × 10(9), and 192.86 ± 25.44 × 10(9), respectively). PT and APTT values correlated positively and significantly with trimester (r = 0.52 and 0.65, respectively; P = 0.01). The PLC of women with APH, PPH, and normal control women correlated negatively with trimester (r = -0.36, -0.54, and -0.28, respectively; P = 0.05). Obstetrics hemorrhage compounded the hemostatic status of pregnant women in Sokoto, Nigeria. There is need for the provision of rapid diagnosis of coagulopathy to guide the provision of best therapeutic management options.
产科出血是全球孕产妇死亡和发病的主要原因。本研究旨在探讨产科出血对凝血酶原时间（PT）、部分凝血活酶时间（APTT）和血小板计数（PLC）的影响。将产科出血的妇女分为产前出血（APH）和产后出血（PPH）两类，无出血的孕妇作为对照组。共有 86 名年龄在 18-45 岁（平均年龄 36.25±10.50 岁）的孕妇因产科出血到尼日利亚索科托州 Sokoto 大都市的 Maryam Abacha 妇女和儿童医院妇产科就诊。纳入 43 名年龄匹配的无出血产妇作为对照组。PT 和 APTT 采用商业制备的 Diagen 试剂试剂盒通过手工方法测定，而 PLC 通过血细胞计数器手工方法测定。APH 组（分别为 20.7±4.226 秒和 46.04±8.689 秒）和 PPH 组（分别为 23.17±2.708 秒和 53.78±4.089 秒）的 PT 和 APTT 结果明显高于正常孕妇（分别为 15.85±0.8930 秒和 36.225±5.010 秒）（P=0.0001）。同样，正常孕妇的 PLC 明显高于 APH 和 PPH 组（分别为 291.425±75.980×10(9)与 154.83±47.019×10(9)和 136.43±43.894×10(9)）（P=0.0001）。PPH 组的 PT 和 APTT 明显高于 APH 组（分别为 23.17±2.708 秒和 53.78±4.089 秒与 20.7±4.226 秒和 46.04±8.689 秒）（P=0.02 和 P=0.04）。APH 组的 PLC 明显高于 PPH 组（P=0.01）。APH 组的孕妇（分别为 24.38±2.33 秒和 52.25±6.71 秒）、PPH 组（分别为 24.75±2.63 秒和 58.25±2.53 秒）和对照组（分别为 16.00±0.82 秒和 34.42±5.59 秒）的第三孕期的 PT 和 APTT 值均高于第一和第二孕期。APH、PPH 和正常孕妇的 PLC 在第三孕期明显较低（分别为 131±23.02×10(9)、99±21.46×10(9)和 192.86±25.44×10(9)）。APH、PPH 和正常对照组妇女的 PT 和 APTT 值与孕期呈正相关且有统计学意义（r=0.52 和 0.65，P=0.01）。APH、PPH 和正常对照组妇女的 PLC 与孕期呈负相关（r=-0.36、-0.54 和-0.28，P=0.05）。产科出血使尼日利亚索科托的孕妇的止血状态恶化。需要快速诊断凝血功能障碍，以指导提供最佳治疗管理选择。
