• M Cortet, C Deneux-Tharaux, C Dupont, C Colin, R-C Rudigoz, M-H Bouvier-Colle, and C Huissoud.
• Hospices civils de Lyon, Service de Biostatistique, F-69003, Lyon, France. marion.cortet@chu-lyon.fr
• Br J Anaesth. 2012 Jun 1;108(6):984-9.

BackgroundThe aim of the study was to determine whether the fibrinogen level at diagnosis of postpartum haemorrhage (PPH) is associated with the severity of bleeding.MethodsThis is a secondary analysis of a population-based study in 106 French maternity units identifying cases of PPH prospectively. PPH was defined by a blood loss exceeding 500 ml during the 24 h after delivery or a peripartum haemoglobin decrease of more than 20 g litre(-1). This analysis includes 738 women with PPH after vaginal delivery. Fibrinogen levels were compared in patients whose PPH worsened and became severe and those whose PPH remained non-severe. Severe PPH was defined as haemorrhage by occurrence of one of the following events: peripartum haemoglobin decrease ≥ 40 g litre(-1), transfusion of concentrated red cells, arterial embolization or emergency surgery, admission to intensive care, or death.ResultsThe mean fibrinogen concentration at diagnosis was 4.2 g litre(-1) [standard deviation (sd)=1.2 g litre(-1)] among the patients without worsening and 3.4 g litre(-1) (sd=0.9 g litre(-1)) (P<0.001) in the group whose PPH became severe. The fibrinogen level was associated with PPH severity independently of other factors [adjusted odds ratio=1.90 (1.16-3.09) for fibrinogen between 2 and 3 g litre(-1) and 11.99 (2.56-56.06) for fibrinogen <2 g litre(-1)].ConclusionsThe fibrinogen level at PPH diagnosis is a marker of the risk of aggravation and should serve as an alert to clinicians.

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