Niepraschk-von Dollen Katja, Bamberg Christian, Henkelmann Anne, Mickley Laura, Kaufner Lutz, Henrich Wolfgang, Pauly Franziska
Department of Obstetrics, Charité-University Medical Center, Berlin, Germany.
Department of Anaesthesiology and Intensive Care Medicine, Charité-University Medical Center, Berlin, Germany.
Arch Gynecol Obstet. 2016 Oct;294(4):745-51. doi: 10.1007/s00404-016-4031-z. Epub 2016 Feb 22.
The present study investigated whether fibrinogen level during the first stage of labor is associated with bleeding severity in the third stage of labor.
We prospectively enrolled 1019 pregnant women with planned vaginal delivery. Upon admission to delivery, maternal fibrinogen levels, hemoglobin content, and coagulation parameters were evaluated. Blood loss in the third stage of labor was systematically measured using a calibrated collecting drape. Univariate and multivariate analyses were performed to identify predictors of PPH (blood loss ≥500 mL) and S-PPH (blood loss ≥1000 mL).
Among 809 vaginal deliveries, mean maternal predelivery fibrinogen was 4.65 ± 0.77 g/L, PPH incidence was 12 %, S-PPH incidence was 3.5 %, and median blood loss was 250 mL. Fibrinogen levels were significantly lower in women with S-PPH (4.22 ± 0.82 g/L) than without S-PPH (4.67 ± 0.75 g/L; p = 0.004), but did not significantly differ between women with PPH (4.67 ± 0.84 g/L) and those without PPH (4.67 ± 0.75 g/L; p = 0.985). Instrumental delivery and predelivery fibrinogen levels were independent predictors of S-PPH. Primiparous status, birth weight >4000 g, genital tract laceration, episiotomy and instrumental delivery were independent predictors of PPH.
For each 1 g/L increase of predelivery fibrinogen level, the risk of S-PPH after vaginal delivery decreases by a factor of 0.405 (95 % CI 0.219-0.750; p = 0.004).
本研究调查了第一产程期间的纤维蛋白原水平是否与第三产程的出血严重程度相关。
我们前瞻性纳入了1019名计划阴道分娩的孕妇。入院分娩时，评估产妇的纤维蛋白原水平、血红蛋白含量和凝血参数。使用校准的收集单系统测量第三产程的失血量。进行单因素和多因素分析以确定产后出血（失血量≥500 mL）和严重产后出血（失血量≥1000 mL）的预测因素。
在809例阴道分娩中，产妇产前平均纤维蛋白原为4.65±0.77 g/L，产后出血发生率为12%，严重产后出血发生率为3.5% , 中位失血量为250 mL。严重产后出血的女性纤维蛋白原水平（4.22±0.82 g/L）显著低于无严重产后出血的女性（4.67±0.75 g/L；p = 0.004），但产后出血的女性（4.67±0.84 g/L）和无产后出血的女性（4.67±0.75 g/L；p = 0.985）之间无显著差异。器械助产和产前纤维蛋白原水平是严重产后出血的独立预测因素。初产妇状态、出生体重>4000 g、生殖道裂伤、会阴切开术和器械助产是产后出血的独立预测因素。
产前纤维蛋白原水平每升高1 g/L，阴道分娩后严重产后出血的风险降低0.405倍（95% CI 0.219 - 0.750；p = 0.004）。
