Can prepartum thromboelastometry-derived parameters and fibrinogen levels really predict postpartum hemorrhage?

Area of Science:

• Obstetrics and Gynecology
• Hematology
• Anesthesiology

Background:

• Postpartum hemorrhage (PPH) is a leading cause of maternal mortality.
• Decreased postpartum rotational thromboelastometry (ROTEM®) parameters and fibrinogen levels are linked to PPH.
• The predictive value of prepartum coagulation parameters for PPH is not well understood.

Purpose of the Study:

• To investigate the predictive capability of prepartum rotational thromboelastometry (ROTEM®) parameters and fibrinogen levels for postpartum hemorrhage (PPH).

Main Methods:

• A prospective observational pilot study involving 217 healthy pregnant women.
• Measurement of maximum clot firmness (FIBTEM-MCF) and fibrinogen levels (Fbgpre) upon admission and within 1 hour postpartum.
• Blood loss assessment using calibrated drapes, with PPH defined as ≥500 mL blood loss.

Main Results:

• No significant difference in median FIBTEM-MCF or mean Fbgpre between women with and without PPH.
• Prepartum coagulation parameters (FIBTEM-MCF, Fbgpre) did not correlate with postpartum blood loss.
• FIBTEM-MCF and Fbgpre showed no significant predictive power for PPH (AUCs 0.52 and 0.53, respectively).
• Primiparity (OR 4.27) and urgent cesarean section (OR 2.77) emerged as independent predictors of PPH.

Conclusions:

• Prepartum ROTEM® parameters and fibrinogen levels do not predict postpartum hemorrhage (PPH).
• Primiparity and urgent cesarean delivery are significant risk factors for PPH.
• Larger, adequately powered studies are required to validate these findings.