Association between fibrinogen level and severity of postpartum haemorrhage: secondary analysis of a prospective trial

The aim of the study was to determine whether the fibrinogen level at diagnosis of postpartum haemorrhage (PPH) is associated with the severity of bleeding. This is a secondary analysis of a population-based study in 106 French maternity units identifying cases of PPH prospectively. PPH was defined by a blood loss exceeding 500 ml during the 24 h after delivery or a peripartum haemoglobin decrease of more than 20 g litre(1). This analysis includes 738 women with PPH after vaginal delivery. Fibrinogen levels were compared in patients whose PPH worsened and became severe and those whose PPH remained non-severe. Severe PPH was defined as haemorrhage by occurrence of one of the following events: peripartum haemoglobin decrease epsilon 40 g litre(1), transfusion of concentrated red cells, arterial embolization or emergency surgery, admission to intensive care, or death. The mean fibrinogen concentration at diagnosis was 4.2 g litre(1) [standard deviation (sd)1.2 g litre(1)] among the patients without worsening and 3.4 g litre(1) (sd0.9 g litre(1)) (P0.001) in the group whose PPH became severe. The fibrinogen level was associated with PPH severity independently of other factors [adjusted odds ratio1.90 (1.163.09) for fibrinogen between 2 and 3 g litre(1) and 11.99 (2.5656.06) for fibrinogen 2 g litre(1)]. The fibrinogen level at PPH diagnosis is a marker of the risk of aggravation and should serve as an alert to clinicians.