OC 02.5 - Prospective study on the peripartal loss of coagulation factors and postpartum hemorrhage in more than 1300 parturient women – the PPH-1300 study

Background: PPH, an increasing major cause of maternal mortality frequently occurs unexpectedly for reasons not well understood.

Aims: To gain better pathophysiological insight through comparison of blood component results before and after delivery.

Methods: Prospective study of >1300 parturient women undergoing standardized measurements of blood loss (MBL); and determination of fibrinogen (FIB), factors II (F.II) and XIII (F.XIII), hemoglobin (HGB) and platelet count (PLT) within 36 hours before and after delivery. Peripartal changes are expressed as the ratio of results after and before delivery. Samples after use of blood products were excluded from analysis. PPH is defined as MBL>500 ml (WHO) [severe PPH as MBL>1000 ml] within 24 hours of delivery.

Results: The extent of coagulation factor alterations increased with blood loss and/or dilution (table 1a), which was associated to the extent of the PPH (table 1b). Changes were always greatest for F.XIII (over F.II, PLT and FIB) and were always highly statistically significant between all components (Friedman test, Kruskal-Wallis test, all p< 0.0001).
Changes in FBG and PLT compared to hemoglobin (peripartal blood loss and/or dilution) show a relative increase (with a significant difference in PPH and non-PPH cases), while a relative decrease results for F.II and F.XIII (repeated measures ANOVA, all p< 0.0001 between all components, figure 1).

Conclusion(s): In this, to date largest, prospective analysis of peripartal hemostatic changes, F.XIII was the single most sensitive component to peripartal loss and/or dilution, similarly in women without and with PPH. Changes in F.XIII were highly significantly different from changes in F.II, PLT and FIB. These results concur with our earlier observation that prepartum F.XIII is much more strongly associated with postpartum blood loss than the other components evaluated (Haslinger et al., JTH, 2020). Given the new results, F.XIII is the prime target for an intervention trial in PPH, over the other components investigated.