UMR 1304, GETBO, Université de Bretagne Occidentale, Brest, France; Internal Medicine, Vascular Medicine and Pneumology Department, Brest University Hospital, Brest, France.
Haemostasis Department, Lyon University Hospital, Lyon, France.
J Thromb Haemost. 2023 Nov;21(11):3099-3108. doi: 10.1016/j.jtha.2023.07.021. Epub 2023 Aug 2.
Severe postpartum hemorrhage (PPH), defined as a blood loss ≥1000 mL, is associated with maternal morbidity and mortality.
We aimed at characterizing coagulation properties of predelivery plasmas from pregnant women with thrombin generation assay and hemostatic biomarkers (plasminogen activator inhibitor-1, tissue factor [TF], and thrombomodulin).
A nested case-control study was conducted within the "Study of Biological Determinants of Bleeding Postpartum," a French prospective cohort study, in order to compare women with severe PPH (cases) and controls matched for age, body mass index, term, and mode of delivery. Plasma was collected at entry in the delivery room, and blood loss was measured objectively. The predelivery endogenous thrombin generation potential (ETP) was measured in plasma using calibrated automated thrombinography and low TF concentration. Hemostatic biomarkers were measured using ELISA kits.
A total of 142 women (71 cases and 71 controls) were investigated. There was no difference in the median lag phase, thrombin peak, and time to peak between cases and controls. However, median predelivery ETP was lower in cases than in controls (2170 vs 2408 nM.min, P < .0001), independently of mode of delivery and PPH etiology. Median plasminogen activator inhibitor-1 and TF levels were higher in cases compared with controls (107.4 vs 68.1 ng/mL, P = .0003; 34.4 vs 27.4 pg/mL, P = .007), whereas thrombomodulin levels did not differ between the 2 groups.
Among thrombin generation assay parameters, predelivery ETP levels may have a predictive value for severe PPH.
产后出血严重（PPH）定义为失血量≥1000ml，与产妇发病率和死亡率相关。
我们旨在通过血栓生成试验和止血生物标志物（纤溶酶原激活物抑制剂-1、组织因子[TF]和血栓调节蛋白）来描述产前血浆的凝血特性。
在法国前瞻性队列研究“产后出血生物学决定因素研究”中进行了嵌套病例对照研究，以比较严重 PPH（病例）和年龄、体重指数、足月和分娩方式匹配的对照组。在进入产房时采集血浆，并客观测量失血量。使用校准自动血栓生成图和低 TF 浓度测量产前内源性血栓生成潜力（ETP）。使用 ELISA 试剂盒测量止血生物标志物。
共调查了 142 名妇女（71 例病例和 71 例对照）。病例组和对照组的中位延滞期、凝血酶峰值和达峰时间无差异。然而，病例组的产前 ETP 中位数低于对照组（2170 对 2408 nM.min，P<0.0001），与分娩方式和 PPH 病因无关。病例组的纤溶酶原激活物抑制剂-1 和 TF 水平均高于对照组（107.4 对 68.1ng/mL，P<0.0003；34.4 对 27.4pg/mL，P=0.007），而两组的血栓调节蛋白水平无差异。
在血栓生成试验参数中，产前 ETP 水平可能对严重 PPH 具有预测价值。
