title: Association between fibrinogen level and severity of postpartum haemorrhage: secondary analysis of a prospective trial.
abstract: BACKGROUND
  The aim of the study was to determine whether the fibrinogen level at diagnosis of postpartum haemorrhage (PPH) is associated with the severity of bleeding.
  
  
  METHODS
  This is a secondary analysis of a population-based study in 106 French maternity units identifying cases of PPH prospectively. PPH was defined by a blood loss exceeding 500 ml during the 24 h after delivery or a peripartum haemoglobin decrease of more than 20 g litre(-1). This analysis includes 738 women with PPH after vaginal delivery. Fibrinogen levels were compared in patients whose PPH worsened and became severe and those whose PPH remained non-severe. Severe PPH was defined as haemorrhage by occurrence of one of the following events: peripartum haemoglobin decrease ≥ 40 g litre(-1), transfusion of concentrated red cells, arterial embolization or emergency surgery, admission to intensive care, or death.
  
  
  RESULTS
  The mean fibrinogen concentration at diagnosis was 4.2 g litre(-1) [standard deviation (sd)=1.2 g litre(-1)] among the patients without worsening and 3.4 g litre(-1) (sd=0.9 g litre(-1)) (P<0.001) in the group whose PPH became severe. The fibrinogen level was associated with PPH severity independently of other factors [adjusted odds ratio=1.90 (1.16-3.09) for fibrinogen between 2 and 3 g litre(-1) and 11.99 (2.56-56.06) for fibrinogen <2 g litre(-1)].
  
  
  CONCLUSIONS
  The fibrinogen level at PPH diagnosis is a marker of the risk of aggravation and should serve as an alert to clinicians.
authors.affiliation: Hospices civils de Lyon, Service de Biostatistique, F-69003, Lyon, France. marion.cortet@chu-lyon.fr
authors.forename: M
authors.initials: M
authors.lastname: Cortet
authors.forename: C
authors.initials: C
authors.lastname: Deneux-Tharaux
authors.forename: C
authors.initials: C
authors.lastname: Dupont
authors.forename: C
authors.initials: C
authors.lastname: Colin
authors.forename: R-C
authors.initials: RC
authors.lastname: Rudigoz
authors.forename: M-H
authors.initials: MH
authors.lastname: Bouvier-Colle
authors.forename: C
authors.initials: C
authors.lastname: Huissoud
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D006801:Humans; D006473:Postpartum Hemorrhage / Q000097:blood*; D011247:Pregnancy; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D005340:Fibrinogen