Evaluation of the Difference in Plasma Fibrinogen Levels Before and After Cesarean Section and its Association with Intra- and Postoperative Bleeding

Background and Objective: Delayed diagnosis and treatment of postpartum hemorrhage could result in mortality. Today, there is a strong desire to determine the factors affecting postpartum hemorrhage, particularly fibrinogen levels. This study aimed to investigate the role of plasma fibrinogen levels in postpartum hemorrhage and severe postpartum hemorrhage.Methods: This cross-sectional study was conducted on ۱۶۹ term pregnant women who were candidates for an elective Cesarean section. Fibrinogen and other coagulating factors were measured before and at the end of the surgery, and twenty-four hours after surgery. Bleeding volume was also measured during and at the end of the surgery, and twenty-four hours after that. The relationship between coagulation factors and the amount of bleeding was examined using statistical tests.Results: Mean plasma fibrinogen levels measured before, at the end of, and ۲۴ hours after surgery were ۲۴۷.۶۵±۹۱.۰۷ mg/dl, ۲۱۹.۴±۷۵.۶۰ mg/dl, and ۲۲۳.۹۱±۶۵.۴۴ mg/dl, respectively. Sixty-five patients (۳۸.۵%) had postpartum hemorrhage (۱۰۰۰-۲۰۰۰mL) and seven patients (۴.۱%) had severe postpartum hemorrhage (>۲۰۰۰mL). Of the cases with preoperative fibrinogen levels less than ۲۰۰mg/dl, ۷۲% had postpartum hemorrhage and ۱۴% had the severe form. There was a strong association between the patient's plasma fibrinogen level with PPH and sPPH (P=۰.۰۰۰).Conclusion: This study showed a strong correlation between plasma fibrinogen levels and postpartum hemorrhage and severe postpartum hemorrhage. In addition, it has been shown that low plasma fibrinogen levels could be a direct prognostic factor for postpartum hemorrhage and severe postpartum hemorrhage. Younger women and preoperative anemia were other strong predictors.

Keywords:

Cesarean Section , Fibrinogen , Postpartum Hemorrhage , Anesthesia