title: Can coagulopathy in post-partum hemorrhage predict maternal morbidity?
abstract: OBJECTIVE
  The purpose of this study was to evaluate the clinical implications of coagulopathy in women with post-partum hemorrhage (PPH).
  
  
  METHODS
  This retrospective cohort study included 262 consecutive women referred for management of PPH at a single tertiary hospital between 2009 and 2012. We reviewed medical records, including vital signs at arrival, laboratory values (hemoglobin, prothrombin time international normalized ratio [PT-INR], platelet, fibrinogen), and total amount of transfused blood product. Results of arterial embolization, need for hysterectomy, and significant morbidity such as pulmonary edema, endometritis or brain lesions were reviewed. Multivariate logistic analysis was used to identify risk of massive transfusion and significant morbidity.
  
  
  RESULTS
  The prevalence of coagulopathy (PT-INR > 1.5) was 29.3% (77/262). Of the 262 women, pelvic arterial embolization was performed in 153 women, and was successful in 146 (95.4%). Hysterectomy was performed in 18 women (6.2%). The presence of coagulopathy led to increased risk for massive transfusion (odds ratio [OR], 23.96; 95%CI: 11.65-49.27), hysterectomy (OR, 9.94; 95%CI: 3.16-31.33), and significant morbidity (OR, 9.37; 95%CI: 4.95-17.75). Even after adjusting for other confounding factors, coagulopathy was independently associated with massive transfusion (adjusted OR, 12.24; 95%CI: 4.49-14.28), hysterectomy (adjusted OR, 4.66; 95%CI: 1.12-19.48), and significant morbidity (adjusted OR, 4.67; 95%CI: 2.05-10.64).
  
  
  CONCLUSIONS
  Coagulopathy in PPH is the single most important predictor for massive transfusion and hysterectomy, and is related to maternal morbidity.
authors: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Gyeonggi, Korea.
authors: Kyung Joon
authors: KJ
authors: Oh
authors: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Gyeonggi, Korea. hjsobgy@snubh.org.
authors: Joon-Seok
authors: JS
authors: Hong
authors: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors: Jina
authors: J
authors: Youm
authors: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Gyeonggi, Korea.
authors: Soo-Hyun
authors: SH
authors: Cho
authors: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Gyeonggi, Korea.
authors: Eun Young
authors: EY
authors: Jung
mesh_terms: D000328:Adult; D000740:Anemia / Q000150:complications / Q000453:epidemiology; D001778:Blood Coagulation Disorders / Q000150:complications / Q000401:mortality*; D001803:Blood Transfusion; D005260:Female; D006801:Humans; D007044:Hysterectomy; D006473:Postpartum Hemorrhage / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors
keywords: coagulopathy; hysterectomy; morbidity; post-partum hemorrhage; transfusion