The presence of placental abruption is an important complication that, in addition to the death of the fetus, can lead to complications in the maternal coagulation system. Changes in this system may be associated with excessive fibrinolysis with DIC, sometimes with a very rapid progression, especially when associated with the condition puerperal bleeding.
During pregnancy, a woman is physiologically prepared for the blood loss associated with childbirth. Among other things, there is a rise in the level of fibrinogen during the last trimester, the value of which reaches about 5 g / l. When fibrinogen is reduced to 3 g/L, the literature agrees that the chance of bleeding complications is high. Levels <2 g/L carry a 100% risk of bleeding complications after insertion according to Charbit et al.
Stady
A French retrospective study on August 20, 2022 re-examined this concept by publishing an article in International Journal of Obstetrics and Gynecology. During 12 years, they evaluated laboratory parameters (platelets, APTT, PT and fibrinogen) and maternal complications (multiple blood transfusions, hysterectomies, multiple organ failure, maternal death) of pregnant women with a singleton pregnancy with fetal death and placental abruption from a week in three hospitals French third class.
No patients had a coagulopathy upon admission to hospital for treatment.
conclusion
The study confirmed that fibrinogen less than 1.9 g/L is an indicator with a sensitivity and specificity of 83% (95% CI) for maternal bleeding complications in fetal death associated with placental abruption in pregnancies above 24 weeks.
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