Predelivery Haemostatic Biomarkers in Women with Non-Severe Postpartum Haemorrhage
Abstract
:1. Introduction
2. Materials and Methods
2.1. Recruitment of Participants, Blood and Data Collection
2.2. Definition of Non-Severe PPH
2.3. Selection of Cases and Controls
2.4. Thrombin Generation Assay (TGA)
2.5. Plasmin Generation Assay (PGA)
2.6. Statistical Analysis
2.7. Ethics Approval
3. Results
3.1. Characteristics of the Pregnant Women
3.2. Predelivery Haemostatic Biomarkers and Their Association with Non-Severe PPH
3.3. Thrombin Generation Assay (TGA)
3.4. Plasmin Generation Assay (PGA)
3.5. Logistic Regression Analysis for Parameters Associated with Non-Severe PPH
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Non-Severe PPH (n = 185) | Controls (n = 185) | p |
---|---|---|---|
Women’s characteristics | |||
Age *, years, median (IQR) | 30 (26–34) | 30 (26–33) | 0.54 |
BMI *, kg/m2, median (IQR) | 23 (21–27) | 23 (21–28) | 0.77 |
25–29.9 kg/m2, n (%) | 44 (23.8%) | 44 (23.8%) | |
≥30 kg/m2, n (%) | 24 (13.0%) | 24 (13.0%) | |
Smokers, n (%) | 51 (27.6%) | 58 (31.4%) | 0.42 |
Blood group | |||
O group, n (%) | 82 (44.3%) | 86 (46.5%) | 0.68 |
Nulliparous, n (%) | 97 (52.4%) | 89 (48.1%) | 0.41 |
Pregnancy characteristics | |||
Conception by ART, n (%) | 21 (11.4%) | 15 (8.1%) | 0.29 |
Gemellar pregnancy, n (%) | 17 (9.2%) | 9 (4.9%) | 0.10 |
Gestational diabetes, n (%) | 20 (10.8%) | 19 (10.3%) | 1.0 |
Gestational weight gain, kg, median (IQR) | 13 (8–18) | 13 (9–17) | 0.85 |
Pre-eclampsia, n (%) | 12 (6.5%) | 9 (4.9%) | 0.50 |
IUGR, n (%) | 6 (3.2%) | 3 (1.6%) | 0.51 |
Placental abruption, n (%) | 2 (1.1%) | 1 (0.5%) | 0.50 |
Abnormal placental insertion, n (%) | 17 (9.2%) | 4 (2.2%) | 0.003 |
Antepartum haemorrhage, n (%) | 25 (13.5%) | 14 (7.6%) | 0.01 |
Delivery characteristics | |||
Term * at delivery, WG, median (IQR) | 39 (37–40) | 39 (37–40) | 0.77 |
Induced labour, n (%) | 69 (37.3%) | 67 (36.2%) | 0.83 |
Vaginal * delivery, n (%) | 72 (38.9%) | 72 (38.9%) | 1.0 |
Instrumental delivery, n (%) | 27 (14.6%) | 17 (9.2%) | 0.11 |
C-section *, n (%) | 113 (61.1%) | 113 (61.1%) | 1.0 |
Emergency C-section, n (%) | 77 (41.6%) | 91 (49.2%) | 0.14 |
Episiotomy, n (%) | 42 (22.7%) | 19 (10.3%) | 0.001 |
Perineal tears, n (%) | 48 (25.9%) | 40 (21.6%) | 0.33 |
Macrosomia, n (%) | 17 (9.2%) | 16 (8.6%) | 0.86 |
Haemostatic Biomarkers | Non-Severe PPH (n = 185) | Controls (n = 185) | p |
---|---|---|---|
Blood count parameters | |||
Haemoglobin, g/dL, median (IQR) | 12.1 (11.4–12.8) | 12.3 (11.4–12.9) | 0.35 |
Platelets, G/L, median (IQR) | 217 (181–259) | 242 (196–280) | 0.003 |
IPF, ratio, median (IQR) | 5.1 (3.3–7.9) | 4.9 (3.1–7.7) | 0.63 |
Conventional haemostatic tests | |||
Prothrombin rate, %, median (IQR) | 100 (94–100) | 99 (94–100) | 0.73 |
aPTT, ratio, median (IQR) | 1.01 (0.95–1.06) | 0.99 (0.94–1.06) | 0.12 |
Fibrinogen, g/L, median (IQR) | 4.85 (4.35–5.63) | 5.09 (4.46–5.56) | 0.32 |
D-dimer, µg/mL, median (IQR) | 1.64 (1.24–2.21) | 1.54 (1.08–2.06) | 0.06 |
Fibrin monomers, µg/mL, median (IQR) | 5.64 (4.39–9.61) | 5.32 (3.98–7.08) | 0.10 |
Thrombin generation assay | |||
Lag phase, min, median (IQR) | 14.1 (12.6–15.1) | 14.1 (12.1–15.6) | 0.89 |
Thrombin peak, nmol/L, median (IQR) | 294.5 (237.5–389.8) | 314.9 (239.3–388.1) | 0.57 |
Time to peak, min, median (IQR) | 23.6 (20.6–25.6) | 23.1 (20.6–25.6) | 0.58 |
Velocity index, nmol/L/min, median (IQR) | 32.6 (22.9–48.3) | 35.1 (24.2–49.0) | 0.50 |
ETP, nmol/L × min, median (IQR) | 5 419 (4 978–5 919) | 5 349 (5 038–5 876) | 0.78 |
Plasmin generation assay | |||
Lag phase, min, median (IQR) | 2.7 (2.6–3.0) | 2.7 (2.3–3.0) | 0.10 |
Plasmin peak, nmol/L, median (IQR) | 66.8 (52.9–78.0) | 67.9 (56.3–78.0) | 0.46 |
Time to peak, min, median (IQR) | 7.3 (7.0–8.0) | 7.3 (7.0–8.0) | 0.67 |
Velocity index, nmol/L/min, median (IQR) | 14.2 (11.9–17.1) | 13.8 (11.4–17.0) | 0.65 |
EPP, nmol/L × min, median (IQR) | 840.8 (540.6–1 111.8) | 844.4 (537.1–1 070.4) | 0.87 |
Biomarker | 25th Percentile | 75th Percentile | Difference | OR | 95% CI | Fraction of New Information |
---|---|---|---|---|---|---|
Platelets (G/L) | 187.50 | 271.50 | 84.00 | 0.61 | 0.37–0.86 | 0.252 |
Immature platelet fraction (%) | 3.25 | 7.95 | 4.70 | 0.76 | 0.51–1.05 | 0.094 |
aPTT ratio (%) | 0.94 | 1.06 | 0.12 | 1.31 | 0.98–2.02 | 0.093 |
Prothrombin time (%) | 94.00 | 100.00 | 6.00 | 1.15 | 0.90–1.51 | 0.066 |
D-dimer (µg/mL) | 1.16 | 2.12 | 0.96 | 1.10 | 0.88–1.96 | 0.024 |
Haemoglobin (g/dL) | 11.40 | 12.90 | 1.50 | 0.92 | 0.65–1.30 | 0.009 |
PC1 plasmin generation assay | −0.92 | 0.96 | 1.88 | 0.93 | 0.63–1.25 | 0.007 |
Fibrinogen (g/L) | 4.41 | 5.58 | 1.17 | 0.96 | 0.65–1.38 | 0.002 |
Fibrin monomers (µg/mL) | 4.20 | 8.23 | 4.04 | 1.00 | 0.94–1.05 | <0.001 |
PC1 thrombin generation assay | −0.75 | 1.12 | 1.87 | 0.99 | 0.72–1.30 | <0.001 |
Adjusted for clinical covariates: | ||||||
Age (years)—matched | 26.00 | 33.00 | 7.00 | 0.99 | 0.78–1.24 | |
BMI (kg/m2)—matched | 20.70 | 27.50 | 6.80 | 1.08 | 0.88–1.34 | |
Nulliparous (yes/no) | No | Yes | 1.18 | 0.73–2.04 | ||
Gemellar pregnancy (yes/no) | No | Yes | 2.01 | 0.62–7.56 | ||
Abnormal placental insertion (yes/no) | No | Yes | 3.37 | 1.06–25.06 | ||
Antepartum haemorrhage (yes/no) | No | Yes | 1.51 | 0.67–3.65 | ||
Pre-eclampsia (yes/no) | No | Yes | 0.77 | 0.14–3.42 | ||
Macrosomia (yes/no) | No | Yes | 1.39 | 0.58–3.58 | ||
Induced labour (yes/no) | No | Yes | 1.09 | 0.67–1.84 | ||
Term at delivery (WG)—matched | 37.00 | 40.00 | 3.00 | 1.04 | 0.80–1.34 | |
Type of delivery—matched (elective/emergency C-section) (vaginal/emergency C-section) | 1.67 1.23 | 0.78–3.97 0.91–1.66 |
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de Moreuil, C.; Pan-Petesch, B.; Mehic, D.; Kraemmer, D.; Schramm, T.; Albert, C.; Trémouilhac, C.; Lucier, S.; Galinat, H.; Le Roux, L.; et al. Predelivery Haemostatic Biomarkers in Women with Non-Severe Postpartum Haemorrhage. J. Clin. Med. 2024, 13, 4231. https://doi.org/10.3390/jcm13144231
de Moreuil C, Pan-Petesch B, Mehic D, Kraemmer D, Schramm T, Albert C, Trémouilhac C, Lucier S, Galinat H, Le Roux L, et al. Predelivery Haemostatic Biomarkers in Women with Non-Severe Postpartum Haemorrhage. Journal of Clinical Medicine. 2024; 13(14):4231. https://doi.org/10.3390/jcm13144231
Chicago/Turabian Stylede Moreuil, Claire, Brigitte Pan-Petesch, Dino Mehic, Daniel Kraemmer, Theresa Schramm, Casilda Albert, Christophe Trémouilhac, Sandy Lucier, Hubert Galinat, Liana Le Roux, and et al. 2024. "Predelivery Haemostatic Biomarkers in Women with Non-Severe Postpartum Haemorrhage" Journal of Clinical Medicine 13, no. 14: 4231. https://doi.org/10.3390/jcm13144231
APA Stylede Moreuil, C., Pan-Petesch, B., Mehic, D., Kraemmer, D., Schramm, T., Albert, C., Trémouilhac, C., Lucier, S., Galinat, H., Le Roux, L., Gebhart, J., Couturaud, F., Wolberg, A. S., Ay, C., & Pabinger, I. (2024). Predelivery Haemostatic Biomarkers in Women with Non-Severe Postpartum Haemorrhage. Journal of Clinical Medicine, 13(14), 4231. https://doi.org/10.3390/jcm13144231