Relationship between prenatal coagulation function and postpartum hemorrhage in pregnant women with placenta previa

Wang Ping; Yang Lijuan; Gao Min; Shang Xiaoyan; Gu Yunna; Wang Guifang; Yang Huadan

doi:10.11986/j.issn.1673-873X.2024.10.09

Abstract：Objective To investigate the relationship between prenatal coagulation function and postpartum hemorrhage in pregnant women with placenta previa(PP),aiming to provide a reference for risk prediction and intervention of postpartum hemorrhage in them.Methods A retrospective analysis was conducted on 136 pregnant women with PP admitted to our hospital from March 2019 to March 2023,who were included in the PP group,and 136 healthy pregnant women who under-went prenatal check-ups at the hospital during the same period were included in the control group.The levels of prenatal co-agulation function indicators[activated partial thromboplastin time(APTT),fibrinogen(FIB),and D-dimer(D-D)]were compared between the two groups.Pregnant women with PP were further allocated to a bleeding group(66 cases)and a non-bleeding group(70 cases)based on the presence or absence of postpartum hemorrhage,and the prenatal coagulation function was compared between the two subgroups.The receiver operating characteristic(ROC)curve was plotted to ana-lyze the predictive value of prenatal APTT,FIB,and D-D levels and their combination for postpartum hemorrhage in preg-nant women with PP;multivariate logistic regression analysis was used to identify the influencing factors of postpartum hemorrhage in these individuals.Results The prenatal APTT in the PP group was significantly longer than that in the con-trol group,the serum FIB level was significantly higher than that in the control group,and the D-D level was significantly lower than that in the control group(P<0.05).The prenatal APTT in the bleeding group of pregnant women with PP was significantly longer than that in the non-bleeding group,the serum FIB level was significantly higher than that in the non-bleeding group,and the D-D level was significantly lower than that in the non-bleeding group(P<0.05).The area under the curve(AUC)for predicting postpartum hemorrhage in pregnant women with PP by combined detection of serum APTT,FIB,and D-D levels was 0.942(95%CI:0.904-0.981),which was higher than that of single indicator detection(P<0.05).The proportion of pregnant women with PP in the bleeding group with abortion times≥3,pregnancy times≥3,intraoperative blood loss≥528.36 m L,no use of interventional techniques,presence of placental adhesion,complete PP type,APTT≥32.494 s,FIB level≥4.048 g/L,and D-D level≤1.867 mg/L was significantly higher than that in the non-bleeding group(P<0.05).Logistic multivariate regression analysis showed that abortion times≥3(OR=1.369;95%CI:1.101-1.702),placental adhesion(OR=2.100;95%CI:1.070-4.122),intraoperative blood loss≥528.36 m L(OR=1.024;95%CI:1.006-1.043),APTT≥32.494 s(OR=1.539;95%CI:1.012-2.341),FIB level≥4.048 g/L(OR=2.071;95%CI:1.317-3.257),and D-D level≤1.867 mg/L(OR=3.916;95%CI:1.534-9.993)were inde-pendent risk factors for postpartum hemorrhage in pregnant women with PP(P<0.05).Conclusion The prenatal coagula-tion function in pregnant women with PP is in an abnormal state.The prenatal coagulation function in those who had post-partum hemorrhage remains worse as compared with pregnant women who did not have postpartum hemorrhage.Further-more,serum APTT,FIB,and D-D levels have predictive value for postpartum hemorrhage in pregnant women with PP,and the predictive value of combined detection of the three is higher.Clinically,these indicators should be closely monitored in pregnant women with PP,and bleeding risk intervention strategies should be implemented to strengthen maternal and in-fant outcomes.