title: Can prepartum thromboelastometry-derived parameters and fibrinogen levels really predict postpartum hemorrhage?
abstract: BACKGROUND
  Decreased postpartum rotational thromboelastometric parameters of coagulation (ROTEM®) and fibrinogen levels have been associated with postpartum hemorrhage (PPH). However, the predictive power of prepartum ROTEM® parameters and fibrinogen levels (Fbgpre) for PPH remains unknown.
  
  
  METHODS
  This prospective observational pilot study included 217 healthy pregnant women. Maximum clot firmness (FIBTEM-MCF), fibrinogen levels and standard coagulation parameters were measured upon admission to the delivery room for labor and within 1 h after vaginal delivery. Blood loss was measured with a calibrated collecting drape during the third stage of labor. PPH was defined as blood loss ≥500 mL. Predictors for bleeding were identified via receiver operating characteristic analyses and bivariate and multivariate regression analyses.
  
  
  RESULTS
  Women with and without PPH did not differ in median FIBTEM-MCF [23 mm (25th percentile 20 mm, 75th percentile 26 mm) vs. 23 mm (19 mm, 26 mm), respectively; P=0.710] or mean Fbgpre (4.57±0.77 g/L vs. 4.45±0.86 g/L, respectively; P=0.431). Blood loss and prepartum coagulation parameters were not correlated (FIBTEM-MCF, rs=-0.055, P=0.431; Fbgpre, rs=-0.017, P=0.810). The areas under the curves (predictive power for PPH) for FIBTEM-MCF and Fbgpre and were 0.52 (0.41-0.64, P=0.699) and 0.53 [95% confidence interval (95% CI) 0.40-0.65, P=0.644], respectively. Neither FIBTEM-MCF nor Fbgpre was associated with PPH. However, primiparity [odds ratio (OR) 4.27, 95% CI 1.32-13.80, P=0.015) and urgent cesarean section (2.77, 1.00-7.67, P=0.050) were independent predictors of PPH.
  
  
  CONCLUSIONS
  ROTEM® parameters, Fbgpre and postpartum blood loss were not associated, nor did these factors predict PPH. Sufficiently powered prospective studies are needed to confirm these results.
authors.affiliation: .
authors.forename: Lutz
authors.initials: L
authors.lastname: Kaufner
authors.affiliation: .
authors.forename: Anne
authors.initials: A
authors.lastname: Henkelmann
authors.affiliation: .
authors.forename: Christian
authors.initials: C
authors.lastname: von Heymann
authors.affiliation: .
authors.forename: Aarne
authors.initials: A
authors.lastname: Feldheiser
authors.affiliation: .
authors.forename: Laura
authors.initials: L
authors.lastname: Mickley
authors.affiliation: .
authors.forename: Katja
authors.initials: K
authors.lastname: Niepraschk-von Dollen
authors.affiliation: .
authors.forename: Ulrike
authors.initials: U
authors.lastname: Grittner
authors.affiliation: .
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Henrich
authors.affiliation: .
authors.forename: Christian
authors.initials: C
authors.lastname: Bamberg
mesh_terms: D000328:Adult; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D010865:Pilot Projects; D006473:Postpartum Hemorrhage / Q000097:blood*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D013916:Thrombelastography; D055815:Young Adult
chemical_list: D005340:Fibrinogen
keywords: EXTEM A10; FIBTEM MCF; fibrinogen; postpartum hemorrhage (PPH); thromboelastometry; urgent cesarean section; vaginal delivery