Clinical Implication Of Coagulation Function Test And Fibrinolytic Molecular Markers Determination In Postpartum Hemorrhage

Objectives:To investigate the changes of coagulation function indexes and fibrinolytic molecular markers in postpartum hemorrhage patients,and to analyze their clinical significanceMethods:50 pregnant women with hemorrhage of 500-1000mL after childbirth in the Second Affiliated Hospital of Kunming Medical University from July 2019 to January 2020 were randomLy selected.According to the mode of delivery,it was divided into the vaginal delivery group(group A,19 patients)and the selective cesarean section group(group B,31 patients).The general information of the two groups(age,height,weight,days of pregnancy,etc.),amount of oxytocin used,infusion of blood products,length of hospital stay,rate of uterine resection,incidence of postpartum anemia,and the death rate were recorded.Collected the venous blood samples at three time points include before delivery(T0),after birth(T1)and after birth 24 hours(T2),and detected in clinical laboratory.The test items included routine blood(Hb,PLT),blood coagulation function(PT,APTT,TT,FIB,DD,FDP,an AT-Ⅲ).Collected the the venous blood samples again at T1&T2 time points,centrifuged(4℃,2000 r/min)and collected the upper serum.F1+2,PLA,PAP,PAI-1 were determined by ELISA.SPSS 23.0 was used for statistical analysis of the collected data.Results:1.Comparison of general data:the age of the patients with selective cesarean section was slightly older than that of the patients with vaginal delivery,and the length of hospital stay was also longer,with statistically significant differences(P<0.05).The number of days of pregnancy in patients with vaginal delivery was longer than that of patients with selective cesarean section,and the difference was statistically significant(P<0.001).The incidence of postpartum anemia was 68.4%in the vaginal delivery patients and 71%in the selective cesarean section patients.2.The correlative factors of postpartum hemorrhage:whatever mode of delivery,the incidence of uterine fatigue was the highest(73.7%in group A and 64.5%in group B),followed by canal injury and trauma(57.9%in group A and 35.5%in group B).The incidence of fibrinolytic hyperactivity was also higher in both groups(36.8%in group A and 48.4%in group B).3.Oxytocin dosage comparison:The oxytocin dosage in patients undergoing vaginal delivery was significantly higher than that of patients undergoing selective cesarean section.and the difference was statistically significant(P<0.001).4.The incidence of complications related to postpartum hemorrhage:no women underwent hysterectomy or died during the study period;The incidence of anemia was high at 24h postpartum,68.4%in group A and 71%in group B.5.Comparison of blood routine,coagulation function and fibrinolytic molecular-markers in group A:compared with T0,Hb and FIB decreased at T1,while DD decreased and FDP increased at T2,with statistically significant differences(P<0.05).DD,FDP increased significantly and AT-Ⅲ decreased significantly at T1,Hb,AT-Ⅲ declined obviously at T2,with significant difference(P<0.001).Compared with T1,FIB increased,F1+2 and PAP decreased at T2,and the difference was statistically significant(P<0.05);Hb,DD,FDP and PL A decreased significantly at T2,and the difference was statistically significant(P<0.001).6.Comparison of blood routine,coagulation function and fibrinolytic molecular markers in group B:compared with T0,PLT,Hb,FIB,AT-Ⅲ were obviously increased and DD,FDP decreased at T1,Hb decreased obviously at T2,there are significant difference statistically significant(P<0.001);AT-Ⅲ decline,FDP incresed at T2,the difference was statistically significant(P<0.05).Compared with T1,Hb,DD,FDP and PLA decreased significantly at T2,while FIB increased significantly(P<0.001).F1+2 and PAP decreased,PLT and AT-Ⅲ increased at T2,the difference was statistically significant(P<0.05).7.The magnitude of FIB decline:compared with T0,15 cases(78.9%)of T1 in the group A showed a decrease of FIB:FIB decreased<Ig/L in 10 cases(66.7%),FIB decreased 1-2g/L in 4 cases(26.7%),and 1 case(6.7%)decreased>2g/L.At T1 of the group B3 FIB decreased in 28 cases(90.3%):FIB decreased<1g/L in 12 cases(42.9%),FIB decreased 1-2g/L in 10 cases(35.7%),and 6 cases(21.4%)FIB decreased>2g/L.8.Correlation analysis:at T1,FIB was positively related with the AT-Ⅲ(correlation coefficient of 0.373,P<0.05),and correlation intensity is weak;At T2,the positive correlation between PLA and FDP(correlation coefficient of 0.429,P<0.05),FIB was positively related with the AT-Ⅲ(correlation coefficient of 0.463,P<0.05),and negatively correlated with the DD(correlation coefficient of 0.328,P<0.05),related to the strength of weak correlation.Conclusions:1.PPH can lead to high levels of blood coagulation activation,but the change about blood coagulation time(PT、APTT、TT)is not obvious,F1+2 and AT-Ⅲ has more clinical significancein in maternal blood coagulation function monitoring.2.Fibrinolytic hyperactivity has a high incidence in PPH patients,and the decrease of FIB at the end of delivery can be caused by fibrinolytic hyperactivity.3.Conventional fibrinolytic indexes(FIB,DD,FDP)combined with fibrinolytic molecular markers(PLA,PAI-1,PAP)can make a comprehensive interpretation of fibrinolytic level in PPH patients.