title: Pre-delivery fibrinogen predicts adverse maternal or neonatal outcomes in patients with placental abruption.
abstract: OBJECTIVE
  Placental abruption is a severe obstetric complication of pregnancy that can cause disseminated intravascular coagulation and progress to massive post-partum hemorrhage. Coagulation disorder due to extreme consumption of fibrinogen is considered the main pathogenesis of disseminated intravascular coagulation in patients with placental abruption. The present study sought to determine if the pre-delivery fibrinogen level could predict adverse maternal or neonatal outcomes in patients with placental abruption.
  
  
  METHODS
  This retrospective medical chart review was conducted in a center for maternal, fetal, and neonatal medicine in Japan with 61 patients with placental abruption. Fibrinogen levels prior to delivery were collected and evaluated for the prediction of maternal and neonatal outcomes. The main outcome measures for maternal outcomes were disseminated intravascular coagulation and hemorrhage, and the main outcome measures for neonatal outcomes were Apgar score at 5 min, umbilical artery pH, and stillbirth.
  
  
  RESULTS
  The receiver-operator curve and multivariate logistic regression analyses indicated that fibrinogen significantly predicted overt disseminated intravascular coagulation and the requirement of ≥6 red blood cell units, ≥10 fresh frozen plasma units, and ≥20 fresh frozen plasma units for transfusion. Moderate hemorrhage occurred in 71.5% of patients with a decrease in fibrinogen levels to 155 mg/dL. Fibrinogen could also predict neonatal outcomes. Umbilical artery pH < 7.00 occurred in 77.1% of patients with a decrease in fibrinogen levels to ≤ 250 mg/dL.
  
  
  CONCLUSIONS
  Pre-delivery fibrinogen can predict adverse maternal as well as neonatal outcomes with placental abruption. © 2016 Japan Society of Obstetrics and Gynecology.
authors.affiliation: Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
authors.forename: Liangcheng
authors.initials: L
authors.lastname: Wang
authors.affiliation: Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Matsunaga
authors.affiliation: Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Mikami
authors.affiliation: Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takai
authors.affiliation: Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
authors.forename: Katsuo
authors.initials: K
authors.lastname: Terui
authors.affiliation: Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Seki
mesh_terms: D000037:Abruptio Placentae / Q000097:blood* / Q000453:epidemiology; D000328:Adult; D001034:Apgar Score; D015415:Biomarkers / Q000097:blood; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D006473:Postpartum Hemorrhage / Q000097:blood / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D005340:Fibrinogen
keywords: disseminated intravascular coagulation; fibrinogen; neonatal outcomes; placental abruption; post-partum hemorrhage