Retrospective Analysis Of Changes In Coagulation Parameters In Patients With Cesarean Section Bleeding

Objective:Retrospective analysis of changes in coagulation parameters in patients with postpartum hemorrhage after elective cesarean sectionMethods:A retrospective analysis method was used to collect 6516 cases of maternity hospitalization in the Second Affiliated Hospital of Kunming Medical University from June 2013 to November 2018,and excluded 6516 cases of cesarean section.There were 405 patients with coagulation parameters and patients with blood loss less than 500 mL.A total of 226 patients with cesarean section blood loss less than 1000 mL were selected from 337 patients,and 226 patients were not transfused during the operation.They were regarded as group A;the elective cesarean section blood loss was≥1000 mL,and the operation was not performed.A total of 111 patients were infused with blood products.Of the 111 patients,80 had not used tranexamic acid during the operation and regarded it as group B.In 31 cases,the patients used different doses of ammonia ring.Acid,treat it as group C;collect the most recent and the first postoperative coagulation index,blood routine,intraoperative blood loss,postoperative 24h bleeding volume,surgery,respectively,in groups A,B,and C.After 24 hours of blood transfusion and hospitalization time,compare the changes of blood coagulation index and blood routine before and after operation in group A and B;compare the changes of blood coagulation index,blood routine and intraoperative blood loss before and after operation in groups B and C.At the same time,the correlation between FIb and intraoperative blood loss,24h postoperative blood loss,postoperative 24h blood transfusion and hospitalization time in the coagulation parameters of group A,B,C,A+B+C were compared.Results:There were no significant differences in preoperative weight,age,and blood routine indicators between Hemoglobin(Hb)and Platelet Count(PLT)in Groups 1A and B(P>0.05).Preoperative coagulation parameters in group 2A and group B:Prothrombin Time(PT),International Standardization Ratio(INR),Activated Partial Thromboplastin Time(APTT),fibrinogen(Fibrinogen,FIb),Thrombin Time(TT),Dosing Dimer Quantification(D-Dimer,DD),Antithrombin Time(AT),Fibrin(Original)Degradation Products(Fibrin(original)Degradation Products,FDPs),the difference was not statistically significant(P>0.05).Compared with blood coagulation index and blood routine before and after operation in group 3A,the differences of PT,INR,APTT,TT,AT,FIb,DD,FDPs,Hb and PLT were statistically significant(P<0.05).Postoperative PT,ENR,APTT,and TT were prolonged compared with preoperative,PLT and AT were lower than preoperative,but still in the normal range,no clinical significance,FIb,Hb decreased compared with preoperative,postoperative DD,FDPs increased compared with preoperative.Compared with blood coagulation index and blood routine before and after operation in group 4B:PT,INR,APTT,FIb,TT,DD,AT,FDPs,Hb,PLT were statistically significant(P<0.05),postoperative PT,APTT TT,TT,FDPs increased after operation,PLT,Hb,AT,Flb decreased compared with preoperative.5 There was no significant difference in postoperative blood coagulation index and blood routine between group A and group B:PT,INR,APTT,TT and AT(P>0.05).The difference of DD,FDPs,FIb,PLT and Hb was statistically significant.(P<0.05),postoperative DD and FDPs in group B were higher than those in group A.FIb,PLT and Hb were lower than group A in group 6B and group C.Preoperative weight,age,operation time and blood routine(Hb,PLT),the difference was not statistically significant(P>0.05),intraoperative blood loss:group B bleeding was greater than group C,the difference was statistically significant(P>0.05).Preoperative coagulation parameters:PT,INR,APTT,FIb,TT,DD,AT,FDPs in group 7B and group C,the difference was not statistically significant(P>0.05).Compared with postoperative coagulation parameters in 8C group:PT,INR,APTT,FIb,TT,DD,AT,FDPs,Hb,PLT were statistically significant(P<0.05),postoperative PT,APTT,TT Preoperative prolongation,postoperative INR,DD,FDPs increased compared with preoperative,Hb,AT,FIb,PLT decreased compared with preoperative.There were no significant differences in postoperative coagulation parameters and blood routine between 9B group and C group:PT,INR,APTT,TT,AT,PLT(P>0.05),and the differences of DD,FDPs,FIb and Hb were statistically significant(P>0.05).P<0.05),and DD and FDPs were higher in group B than in group C,and FIb and Hb were lower than group C.There was a statistically significant difference in the amount of bleeding between 24h and 24h after operation,and the amount of blood transfusion and hospitalization at 24h after operation(P<0.05).The amount of bleeding in group B after 24h and 24h after operation were more than that in group C.Time is longer than Group C.There was a signifieant correlation between intraoperative blood loss and postoperative FIb in group 11 A,B and C(P<0.05).All samples(A+B+C)also had intraoperative blood loss and postoperative FIb.Correlation(P<0.05),the lower the FIb,the greater the amount of bleeding.There was a significant correlation between postoperative FIb and 24h postoperative bleeding in group 12A,B and C(P<0.05).All sanples(A+B+C)were between FIb and 24h postoperative bleeding.There was also a correlation(P<0.05),and the lower the FIb,the greater the amount of bleeding within 24 hours after surgery.There was a significant correlation between postoperative FIb and blood transfusion at 13h after operation in group 13B,C and B+C(P<0.05).The lower the FIb,the higher the blood transfusion at 24h after operation.There was a significant correlation between FIB in 14A,B,C and A+B+C groups(P<0.05).The lower the FIb,the longer the hospital stay.Conclusions:Postpartum hemorrhage in patients with massive hemorrhage due to cesarean section is associated with fibrinolysis and low fibrinogen.The early use of tranexamic acid(when blood loss≥1000mL)can inhibit hyperfibrinolysis in patients with postpartum hemorrhage after eesarean section.The amount of intraoperative blood loss,the amount of bleeding after 24 hours,the blood transfusion after 24 hours,and the length of hospital stay in patients with postpartum hemorrhage.