Diagnostic value of fibrinogen combined with thromboelastogram in postpartum hemorrhage after vaginal delivery

Abstract

Objective: To investigate the diagnostic value of fibrinogen (Fib) combined with thromboelastogram (TEG) in postpartum hemorrhage (PPH) after vaginal delivery.

Methods: A total of 120 women who underwent vaginal delivery in our hospital were divided into a PPH group (n=50) and a non-PPH group (n=70). The reaction time (R), clotting time (K), Fib, and D-dimer (D-D) levels were compared between the two groups. Patients in the PPH group were sub-divided into a mild hemorrhage group (n=28) and a severe hemorrhage group (n=22). The receiver operator characteristic curves of R, K, Fib, and D-D for predicting PPH were plotted respectively.

Results: The levels of R, K, and D-D in the PPH group were significantly higher than those in the non-PPH group. The Fib level was significantly lower than that in the non-PPH group (P<0.05). The severe hemorrhage group had significantly higher maternal R, K, and D-D levels and a significantly lower Fib level than the mild hemorrhage group (P<0.05). Correlation analysis showed that Fib was negatively correlated with R and K, and the D-D was positively correlated with R and K (P<0.05). The area under the curves of R, K, Fib, and D-D were 0.9690, 0.9917, 0.8512, and 0.8771, respectively (P<0.05).

Conclusion: Fib and TEG have good diagnostic values for PPH in women who underwent vaginal delivery, and can better predict PPH, providing evidence for clinical prevention and treatment of PPH.

Keywords: Fibrinogen; postpartum hemorrhage; thromboelastogram; vaginal delivery.

Figure 1

Comparison of maternal coagulation indicators and TEG indicators between PPH and non-PPH groups. A: Reaction time (R); B: Clotting time (K); C: Fibrinogen (Fib); D: D-dimer (D-D). #Denotes comparison with non-PPH group, P<0.05.

Figure 2

Comparison of coagulation indicators and TEG indicators between severe and mild hemorrhage groups. A: Reaction time (R); B: Clotting time (K); C: Fibrinogen (Fib); D: D-dimer (D-D). #Denotes comparison with mild hemorrhage group, P<0.05.

Figure 3

Correlation analysis of PPH maternal coagulation indicators with TEG indicators. A and B: Fib was negatively correlated with R (r=-0.9377, P<0.0001) and K (r=-0.9429, P<0.0001); C and D: D-D was positively correlated with R (r=0.9605, P<0.0001) and K (r=0.9663, P<0.0001).

Figure 4

Analysis of the predictive value of routine coagulation and TEG indicators for PPH. The analysis showed that the diagnostic AUC of Fib for PPH was 0.8512 (95% CI 0.7337-0.9688, P<0.0001), the diagnostic AUC of D-D for PPH was 0.8771 (95% CI 0.7798-0.9744, P<0.0001), the diagnostic AUC of R for PPH was 0.9690 (95% CI 0.9270-1.000, P<0.0001), and the diagnostic AUC of K for PPH was 0.9917 (95% CI 0.9729-1.000, P<0.0001).