Hemostatic biomarkers associated with postpartum hemorrhage: a systematic review and meta-analysis

Abstract

Background:Postpartum hemorrhage (PPH) is a leading cause of maternal morbi-mortality. While obstetric risk factors are well described, the impact of predelivery hematological and hemostatic biomarkers remains incompletely understood. Aims:In this systematic review, we aimed to summarize the available literature on the association between predelivery hemostatic biomarkers and PPH/severe PPH. Methods: Searching MEDLINE, EMBASE, and CENTRAL from inception to October 2022, we included observational studies on unselected pregnant women without bleeding disorder reporting on PPH and on predelivery hemostatic biomarkers. Two review authors independently performed title, abstract, and full text screening, upon which quantitative syntheses of studies reporting on the same hemostatic biomarker were conducted, calculating mean differences (MD) between women with PPH/severe PPH and controls. Results: Search of databases on October 18th, 2022 yielded 81 articles fitting our inclusion criteria. The heterogeneity between studies was considerable. With regard to PPH in general, the estimated average MD in investigated biomarkers (platelets, fibrinogen, hemoglobin, D-Dimer, aPTT, PT) were not statistically significant. Women who developed severe PPH had lower predelivery platelets than controls (MD = -26.0 G/L; 95%CI -35.8, -16.1), whereas differences in predelivery fibrinogen concentration (MD = -0.31 g/L; 95%CI -0.75, 0.13) and levels of Factor XIII (MD = -0.07 IU/mL; 95%CI -0.17, 0.04) or hemoglobin (-0.25 g/dL; 95%CI -4.36, 3.85) were not statistically significant in women with and without severe PPH. Conclusion: Predelivery platelet counts were on average lower in women with severe PPH compared with controls, suggesting the potential usefulness of this simple biomarker for predicting severe PPH.

Utility of Global Hemostatic Assays in Patients with Bleeding Disorders of Unknown Cause

“…56 Viscoelastic testing is used in a variety of clinical settings and provides valuable insight into various medical scenarios, including presurgical assessment, trauma-related coagulopathy, PPH management, cirrhosis procedures, and critical care. 29,57 Viscoelastic testing can also identify different states of fibrinolysis in blood, including hyperfibrinolysis, physiologic fibrinolysis, and fibrinolysis shutdown. 58 Viscoelastic assays have also been extensively studied as a diagnostic tool for MBDs, 56 including VWD 59,60 and CFD such as hemophilia A/B, 56,61 but the partly conflicting results did not lead to the implementation of these assays in the diagnostic workup of these bleeding disorders.…”

Postpartum Haemorrhage and Carboprost for Its Prevention: A Narrative Review

“…PPH may result from widespread intravascular coagulopathy, which includes sepsis, amniotic fluid embolism, significant blood loss or transfusion, intrauterine fetal death with protracted retention of a dead fetus, and placental abruption. Excessive blood loss after giving birth is also linked to other coagulation diseases such as thrombocytopenia, von Willebrand disease, and anticoagulant medication [ 11 ]. Research has indicated a connection between advanced maternal age and PPH, but there is currently insufficient agreement on this topic.…”

A Retrospective before and after Assessment of Multidisciplinary Management for Postpartum Hemorrhage

“…Iron deficiency anemia (IDA) occurs in almost 7% of all pregnant women and can be treated during pregnancy [19]. Women with IDA are at greater risk for peripartum RBC administration [20].…”