Is serum fibrinogen an affirmative marker for vaginal delivery without PPH?
Rachna Agarwal, Neha Jaiswal, Rajarshi Kar, Alpana Singh, Himsweta Srivastava
Objective: This study was conducted to see whether predelivery serum fibrinogen is a positive marker for conception ending with ‘physiological’ blood loss instead of predicting PPH. Methods: Low-risk pregnant women after 24 weeks of gestation with singleton pregnancy were prospectively followed for spontaneous vaginal delivery. Predelivery blood samples collected antenatally were preserved for estimation of serum fibrinogen. We excluded patients with altered coagulation profile, anemia, thrombocytopenia, hypertension, gestational diabetes and cholestasis. Final analysis compared fibrinogen levels in non-PPH and PPH subjects (n=40 each). Results: The serum fibrinogen levels in non-PPH was 2.80±0.55g/L and in PPH group was 1.07±0.48g/L (p<0.001). Correlation of predelivery fibrinogen and blood loss among subjects predicted a negative correlation (r = −0.695, p<0.001). There were no PPH cases when serum fibrinogen level was >2.63g/L (sensitivity 82.5%, specificity 100%). Conclusions: Prenatal serum fibrinogen level above 2.6g/L is suggested as potential alert marker for maternal well being (with non-PPH) in vaginal delivery.