evaluation of the differences in plasma fibrinogen levels before and after cesarean section and its association with intra- and postoperative bleeding

Background objective: delayed diagnosis and treatment of postpartum hemorrhage could result in mortality. today, there is a strong desire to determine the factors affecting postpartum hemorrhage, particularly fibrinogen levels. this study aimed to investigate the role of plasma fibrinogen levels in postpartum hemorrhage and severe postpartum hemorrhage.materials methods: this cross-sectional study was conducted on 169 term pregnant women who were candidates for an elective cesarean section. fibrinogen and other coagulating factors were measured before and at the end of the surgery, and twenty-four hours after surgery. bleeding volume was also measured during and at the end of the surgery, and twenty-four hours after that. the relationship between coagulation factors and the amount of bleeding was examined using statistical tests.results: mean plasma fibrinogen levels measured before, at the end of, and 24 hours after surgery were 247.65±91.07 mg/dl, 219.4±75.60 mg/dl, and 223.91±65.44 mg/dl, respectively. sixty-five patients (38.5%) had postpartum hemorrhage (1000-2000ml) and seven patients (4.1%) had severe postpartum hemorrhage (>2000ml). of the cases with preoperative fibrinogen levels less than 200mg/dl, 72% had postpartum hemorrhage and 14% had the severe form. there was a strong association between the patient’s plasma fibrinogen level with pph and spph (p=0.000).conclusion: this study showed a strong correlation between plasma fibrinogen levels and postpartum hemorrhage and severe postpartum hemorrhage. in addition, it has been shown that low plasma fibrinogen levels could be a direct prognostic factor for postpartum hemorrhage and severe postpartum hemorrhage. younger women and preoperative anemia were other strong predictors.