Effect of hypofibrinogenemia on obstetrical disseminated intravascular coagulation in Japan in 2018: a multicenter retrospective cohort study

Japanese obstetrical hemorrhage recommendations state that not only pregnant women with an obstetrical disseminated intravascular coagulation (DIC) score >= 8 points but also those with fibrinogen levels <= 1.5 g/L have a high risk of maternal death and warrant blood transfusion. Our aim was to demonstrate the potential of fibrinogen levels <= 1.5 g/L as predictors of a Japanese obstetrical DIC score of >= 8. We included 595 participants with blood loss >= 1000 mL during vaginal delivery or >= 2000 mL during cesarean delivery. The frequency and volume of red blood cell (RBC), fresh-frozen plasma, platelet concentrate (PC), and fibrinogen administration in women with a DIC score of >= 8 and fibrinogen levels of <= 1.5 g/L were significantly higher than controls (P < 0.0001). Multivariate analysis demonstrated that a score of >= 3 was associated with RBC or fibrinogen administration and a score of >= 5 was associated with PC transfusion. Fibrinogen levels <= 1.89 g/L and <= 2.44 g/L were associated with PC transfusion and fibrinogen administration, respectively. Fibrinogen levels <= 1.5 g/L may have similar potential to a DIC score of >= 8 points for detecting obstetrical DIC in Japan.