Association of fibrinogen levels with severity of postpartum hemorrhage and contributing risk factors

Authors

  • Munazza Abbas Holy Family Hospital, Rawalpindi Pakistan / Islamabad Diagnostic Center, Islamabad Pakistan
  • Muna Matloob Bukhari Holy Family Hospital, Rawalpindi Pakistan/ District Headquarter Hospital, Kotli Azad Kashmir
  • Fariha Sardar Holy Family Hospital, Rawalpindi Pakistan / Social Security Dispensary, Attock Pakistan
  • Hajra Azhar Holy Family Hospital, Rawalpindi Pakistan / Islamabad Diagnostic Center, Islamabad Pakistan
  • Shazia Shabbar Holy Family Hospital, Rawalpindi Pakistan / Social Security Dispensary, Attock Pakistan

DOI:

https://doi.org/10.55629/pakjpathol.v36i2.907

Abstract

Objective: To determine mean fibrinogen levels in postpartum hemorrhage and to compare mean fibrinogen levels in mild postpartum hemorrhage versus severe postpartum hemorrhage.

Material and Methods: This Comparative cross-sectional study was conducted at the department of Gynecology in Holy Family Hospital, Rawalpindi with a duration of 06 months from January 2020 – June 2020. Sixty (60) postpartum hemorrhage patients aged 25-45 years were included. Hemorrhage caused by surgery like uterine rupture or wound of birth canal, coagulation disorders, and disseminated intravascular coagulation was excluded. Fibrinogen concentration was measured using Clauss assays with the help of an automated analyzer (Zonci xl1000s). Results were compared using an independent t-test.

Result: The study included 60 patients with a mean age of 31.0 (4.7) years. The mean fibrinogen level among patients was 248.13 (72.9) mg/dl. In mild postpartum hemorrhage cases (32 patients), the mean fibrinogen level was 291.56 (69.8) mg/dl, while in severe cases (28 patients), it was 198.50 (35.2) mg/dl. The p-value of fibrinogen was 0.00, indicating a significant difference between the groups. No association was found between fibrinogen levels and age, parity, scar, or delivery mode (p-value > 0.05).

Conclusion: This study concluded that mean fibrinogen levels in severe postpartum hemorrhage are less than 200mg/dl, as compared to the mean fibrinogen levels in mild postpartum hemorrhage which were greater than 25 0mg/dl and the difference is statistically significant.

Keywords: Fibrinogen, Hemorrhage, Postpartum, Pregnancy, Severity.

References

Ueda A, Nakakita B, Chigusa Y, Mogami H, Ohtera S, Kato G, et al. Impact of efforts to prevent maternal deaths due to obstetric hemorrhage on trends in epidemiology and management of severe postpartum hemorrhage in Japan: A nationwide retrospective study. BMC Pregnancy Childbirth. 22, no. 1 (2022): 496. DOI: https://doi.org/10.1186/s12884-022-04824-7

Brown M, Hong Jr M, Lindquist J. Uterine artery embolization for primary postpartum hemorrhage. Tech Vasc Interv Radiol. 2021; 24(1): 100727. DOI: https://doi.org/10.1016/j.tvir.2021.100727

Bláha J, Bartošová T. Epidemiology and definition of PPH worldwide. Best Prac Res Clin Anaesthesiol. 2022; 36(3-4): 325-39. DOI: https://doi.org/10.1016/j.bpa.2022.11.001

Petca A, Plăcintă AT, Rotar IC, Mehedinţu C, Dănău RA, Petca RC. Postpartum hemorrhage management according to the underlying cause. Obstetrica si Ginecologie. 2022; 4(70): 421. DOI: http://dx.doi.org/10.26416/ObsGin.70.4.2022.7490

Mahalingam HV, Rangasami R, Premkumar J, Chandrasekar A. Placenta accreta scoring system (PASS)—assessment of a simplified clinico_radiological scoring system for antenatal diagnosis of placenta accreta. Egypt J Radiol Nucl Med. 2021; 52: 42. DOI: https://doi.org/10.1186/s43055-021-00427-y

Wormer KC, Jamil RT, Bryant SB. Postpartum Hemorrhage. [Updated 2024 Jul 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499988 /

Watkins EJ, Stem K. Postpartum hemorrhage. JAAPA. 2020; 33(4): 29-33. DOI: https://doi.org/10.1097/01.jaa.0000657164.11635.93

Warren BB, Moyer GC, Manco-Johnson MJ. Hemostasis in the Pregnant Woman, the Placenta, the Fetus, and the Newborn Infant. Semin Thromb Hemost. 2023 Jun;49(4): 319-29. DOI: https://doi.org/10.1055/s-0042-1760332

Vermeulen T, Van de Velde M. The role of fibrinogen in postpartum hemorrhage. Best Pract Res Clin Anaesthesiol. 2022; 36(3-4): 399-410. DOI: https://doi.org/10.1016/j.bpa.2022.10.002

Nencini F, Giurranna E, Borghi S, Taddei N, Fiorillo C, Becatti M. Fibrinogen oxidation and thrombosis: shaping structure and function. Antioxidants (Basel). 2025; 14(4): 390. DOI: https://doi.org/10.3390/antiox14040390

Zaitoun MM, Elbhiedy TM, Jama IIA, Wasfy MA. Study of plasma D-dimer level in normal pregnancy and complicated pregnancy. Egyptian J Hosp Med. 2023: 90 (2); 3266-72. DOI: https://doi.org/10.21608/ejhm.2023.291015

Kaur K, Grover S, Kukar N, Tapasvi I, Garg M, Singla R. The association of serum fibrinogen levels with the severity of primary postpartum hemorrhage: A prospective study. Cureus. 2024; 16(10): e71397. DOI: https://doi.org/10.7759/cureus.71397

Edris YM, Eloraby NG, Elmoghney MAA, Tawfik WM. Use of fibrinogen in prevention and management of postpartum haemorrhage in high risk patient. Benha Med J. 2024; 41 (4): 126-35. Available from: https://bmfj.journals.ekb.eg/article _345873_8547fb8c28c84e8338d4f8468d9ca470.pdf

Charbit B, Mandelbrot L, Samain E, Baron G, Haddaoui B, Keita H et al. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage. J Thromb Haemost 2007; 5(2): 266-73. DOI: https://doi.org/10.1111/j.1538-7836.2007.022 97.x

Deleu F, Deneux-Tharaux C, Chiesa-Dubruille C, Seco A, Bonnet MP; EPIMOMS study Group. Fibrinogen concentrate and maternal outcomes in severe postpartum hemorrhage: A population-based cohort study with a propensity score-matched analysis. J Clin Anesth. 2022; 81: 110874. DOI:https://doi.org/10.1016/j.jclinane.2022.110874

Zhu X, Tang J, Huang X, Zhou Y. Diagnostic value of fibrinogen combined with thromboelastogram in postpartum hemorrhage after vaginal delivery. Am J Transl Res. 2022; 14(3): 1877-83. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC89 911 41/pdf/ajtr0014-1877.pdf

Velásquez VG, Agudelo MG, Ospina AC, Castellanos RA. Association between fibrinogen levels and the severity of postpartum haemorrhage. Rev Colomb Anestesiol. 2015; 43(2): 136-41. DOI: https://doi.org/10.1016/j.rcae.2015.01.003

Al-Zirqi I, Vangen S, Forsén L, Stray-Pedersen B. Effects of onset of labor and mode of delivery on severe postpartum hemorrhage. Am J Obstet Gynecol. 2009; 201(3): 273.e1-9. DOI: https://doi.org/10.1016/j.ajog.2009.06.007

Xu C, Zhong W, Fu Q, Yi L, Deng Y, Cheng Z, et al. Differential effects of different delivery methods on progression to severe postpartum hemorrhage between Chinese nulliparous and multiparous women: A retrospective cohort study. BMC Pregnancy Childbirth. 2020; 20(1): 660. DOI: https://doi.org/10.1186/s12884-020-03351-7

Charbit B, Mandelbrot L, Samain E, Baron G, Haddaoui B, Keita H et al. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage. J Thromb Haemost 2007; 5(2): 266-73.

DOI: https://doi.org/10.1111/j.1538-7836.2007.022 97.x

Sahin AS, Ozkan S. Treatment of obstetric hemorrhage with fibrinogen concentrate. Med Sci Monit. 2019; 25: 1814-21. DOI: https://doi.org/10.12659/MSM.914234

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Published

30-06-2025

How to Cite

1.
Abbas M, Bukhari MM, Sardar F, Azhar H, Shabbar S. Association of fibrinogen levels with severity of postpartum hemorrhage and contributing risk factors. Pak J Pathol [Internet]. 2025 Jun. 30 [cited 2026 Oct. 28];36(2):138-43. Available from: https://pakjpath.com/index.php/Pak-J-Pathol/article/view/907