title: Fibrinogen plasma concentration before delivery is not associated with postpartum haemorrhage: a prospective observational study.
abstract: BACKGROUND
  Low plasma fibrinogen concentration has been linked to postpartum haemorrhage. The primary aim of this study was to assess whether fibrinogen concentration at admission before labour is associated with severe postpartum haemorrhage. Secondary aims were to describe fibrinogen concentration before and after labour and to identify predictors for severe postpartum haemorrhage.
  
  
  METHODS
  1951 healthy women were included in a prospective observational study. Fibrinogen concentration was determined at admission to the labour ward and in a subgroup of women (n=80) also after the placenta was delivered. Bleeding volume postpartum was estimated by weighing surgical sponges and pads and by measuring collected blood. Predictors for severe postpartum haemorrhage (>1000 ml) were identified with bivariate and multivariate regression analyses.
  
  
  RESULTS
  Mean fibrinogen concentration was 5.3 (SD 0.8) g litre(-) (1). Median estimated blood loss was 450 (range 70-4400) ml and 250 (12.8%) women bled >1000 ml. Fibrinogen concentration was not correlated with postpartum haemorrhage in the entire cohort (r(s)=0.003, P=0.90) or in any subgroup. Fibrinogen concentration was not associated with bleeding >1000 ml (odds ratio 1.01 (CI 95% 0.85-1.19), P=0.93) and did not differ significantly before and after delivery. Oxytocin stimulation, instrumental delivery, Caesarean section and exploration of uterus were identified as independent predictors of haemorrhage >1000 ml.
  
  
  CONCLUSIONS
  Fibrinogen plasma concentration at admission before labour does not predict severe postpartum haemorrhage in a general obstetric population. Fibrinogen concentration does not decrease significantly during normal labour. Excessive postpartum bleeding is mainly as a result of obstetric complications.
authors: Department of Anaesthesiology, Sahlgrenska University Hospital, Gothenburg, Sweden ove.i.karlsson@vgregion.se.
authors: O
authors: O
authors: Karlsson
authors: Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors: A
authors: A
authors: Jeppsson
authors: Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: M
authors: M
authors: Thornemo
authors: Department of Anaesthesiology, Södra Älvsborg Hospital, Borås, Sweden.
authors: H
authors: H
authors: Lafrenz
authors: Department of Anaesthesiology, Norra Älvsborg Hospital, Trollhättan, Sweden.
authors: M
authors: M
authors: Rådström
authors: Department of Obstetrics, Sahlgrenska University Hospital, Gothenburg, Sweden Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Department of Antenatal Care, Närhälsan, Primary Care, Västra Götaland, Sweden.
authors: M
authors: M
authors: Hellgren
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D006801:Humans; D006473:Postpartum Hemorrhage / Q000097:blood*; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D005340:Fibrinogen
keywords: delivery; fibrinogen; obstetric labor complications; postpartum hemorrhage