title: Higher D-dimer level in the early third trimester predicts the occurrence of postpartum hemorrhage.
abstract: OBJECTIVE
  This study aimed to determine effective predictive factors for primary postpartum hemorrhage (PPH) among clinical blood parameters associated with coagulation and fibrinolysis and demographic characteristics.
  
  
  METHODS
  We retrospectively studied 1032 women who underwent determinations of clinical blood parameters at gestational week (GW) 29-32 and GW 35-37 and gave birth to singleton infants at our hospital between January 2011 and December 2013. PPH was defined as estimated blood loss ≥700 mL. Multivariate logistic regression analyses were used to determine independent risk factors and odds ratios (OR) for PPH.
  
  
  RESULTS
  PPH occurred in 104 of 1032 women (10%). Three blood variables, fibrinogen level <4.0 g/L (OR [95% CI], 1.96 [1.18-3.27]), antithrombin activity <85% of normal activity level (1.84 [1.05-3.21]), and D-dimer level >2.7 μg/mL (2.03 [1.29-3.19]) at GW 35-37, and three demographic characteristics, maternal age ≥35 years (1.75 [1.15-2.68]), BMI >28.2 kg/m2 on admission for childbirth (1.95 [1.20-3.16]), and previous cesarean delivery (2.77 [1.31-5.83]), were identified as independent risk factors for PPH.
  
  
  CONCLUSIONS
  Among blood parameters, higher D-dimer levels and lower levels of antithrombin activity and fibrinogen in late gestation were independent risk factors for PPH.
authors.forename: Naho
authors.initials: N
authors.lastname: Endo-Kawamura
authors.forename: Mana
authors.initials: M
authors.lastname: Obata-Yasuoka
authors.forename: Hiroya
authors.initials: H
authors.lastname: Yagi
authors.forename: Rena
authors.initials: R
authors.lastname: Ohara
authors.forename: Yuko
authors.initials: Y
authors.lastname: Nagai
authors.forename: Miyuki
authors.initials: M
authors.lastname: Mayumi
authors.forename: Kanako
authors.initials: K
authors.lastname: Abe
authors.forename: Hiromi
authors.initials: H
authors.lastname: Hamada
mesh_terms: D000293:Adolescent; D000328:Adult; D000991:Antithrombins / Q000097:blood; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002585:Cesarean Section; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D008875:Middle Aged; D006473:Postpartum Hemorrhage / Q000097:blood* / Q000209:etiology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011263:Pregnancy Trimester, Third / Q000097:blood*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000991:Antithrombins; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005340:Fibrinogen