Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.
Department of Obstetrics and Gynecology, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey.
J Matern Fetal Neonatal Med. 2022 Aug;35(15):2829-2835. doi: 10.1080/14767058.2020.1803261. Epub 2020 Aug 10.
Postpartum hemorrhage (PPH) is the single largest contributor to maternal mortality worldwide. It has been demonstrated that certain platelet parameters are indicative of platelet reactivity. The aim of this study was to determine whether antenatal platelet indices can be used as risk factors in the prediction of primary PPH.
This comparative case-control study involved 3207 pregnant women at term who were recruited over one year period in İstanbul. Postpartum hemorrhage, defined as blood loss ≥1000 mL within 24 h after delivery. The study group consisted of 42 patients who developed primary PPH after vaginal delivery without defined risk factors. The patients in the control group were matched with age, parity, body mass index (BMI), and hemoglobin value. Platelet indices - platelet count, mean platelet volume (MPV), platelet distribution width, and plateletcrit were measured prior to delivery and evaluated for the prediction of PPH.
Prepartum MPV and PDW values were determined to be lower in the patients with in the PPH group, when compared to the healthy group (respectively, < .001 and < .004). By receiver-operating characteristic analysis, MPV and PDW were able to distinguish between patients with and without any bleeding (respectively, AUC 0.823, 95% confidence interval (CI) 0.735-0.912, (AUC) 0.682, 95% CI 0.569-0.795). Prepartum MPV (cutoff = 10.95 fL) had a high AUC (>0.8) for predicting PPH, with a specificity of 81% and sensitivity of 69%.
Results suggest a novel hypothesis that pre-delivery lower MPV value may be used predicting PPH.
产后出血（PPH）是全球导致产妇死亡的最大单一原因。已经证明，某些血小板参数可反映血小板反应性。本研究旨在确定产前血小板指数是否可用作预测原发性 PPH 的危险因素。
本项为期一年的回顾性病例对照研究共纳入了 3207 名足月妊娠的孕妇。产后出血定义为分娩后 24 小时内出血量≥1000mL。研究组包括 42 名在阴道分娩后无明确危险因素发生原发性 PPH 的患者。对照组患者按照年龄、产次、体重指数（BMI）和血红蛋白值进行匹配。在分娩前测量血小板计数、平均血小板体积（MPV）、血小板分布宽度和血小板压积，并评估其对 PPH 的预测价值。
与健康组相比，PPH 组患者的产前 MPV 和 PDW 值较低（分别为 < .001 和 < .004）。通过接受者操作特征分析，MPV 和 PDW 能够区分有无出血的患者（分别为 AUC 0.823，95%置信区间（CI）0.735-0.912，（AUC）0.682，95% CI 0.569-0.795）。产前 MPV（截断值=10.95 fL）对预测 PPH 具有较高的 AUC（>0.8），特异性为 81%，敏感性为 69%。
结果提示一个新假说，即分娩前较低的 MPV 值可能用于预测 PPH。
