Evaluation of antepartum blood fibrinogen and calcium levels on postpartum hemogram parameters

Objective: The aim of this study is to investigate the effects of calcium (factor 4) and fibrinogen (factor 1) values on the postpartum hemorrhage rate in postpartum hemogram parameters of pregnant women with normal vaginal delivery in coagulation cascade. Materials and Methods: This study was carried out retrospectively by examining the file records of 200 patients between 17th-45th years, who were admitted to Recep Tayyip Erdoğan University Medical Faculty Hospital of Obstetrics and Gynecology between January 01, 2015 and December 31, 2016 and vaginal delivery was performed during the week of 37-42 gestation. Routine biochemistry, hemogram, coagulation, total calcium, fibrinogen values, prenatal vaginal examination findings, birth induction methods, obstetric ultrasonographic findings, birth weights of the born babies, gender, episiotomy State, gravida, parity, abortus numbers and previous birth weights were recorded. It was also recorded in the information on the hemograms of women during pregnancy and during the first postnatal 24th hour. The values of fasting blood sugar, fibrinogen, total calcium, aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, creatinine, total protein, albumin, prothrombin time, International Normalized Ratio (INR) value, active partial thromboplastin time (aPTT), and other laboratory findings were recorded. Analysis of the data collected in the study was made using statistical software package SPSS 23 (Statistical Package for the Social Sciences - IBM®). Descriptive statistics were presented as numbers and percentages for categorical variables, mean and standard deviation for numerical variables. The ANOVA test was used when the normal distribution assumption was provided for multiple independent group comparisons for the numerical variables, and the Kruskal Wallis test was used when not. For categorical variables, Chi-square test and T-test statistic were used. To determine the statistical significance level, 95% confidence interval and p <0.05 were considered significant. Results: The average age of the women in the study was 17-45 years and the mean age was 28.75 ± 5.87 years and the average weight was determined as 75.23 ± 12.3 kg. There was no statistically significant correlation between birth weight and age (p <0,05) and weight (p> 0,05). In the study, it was determined that all women had a term gestational week and the mean gestational week was 39.41 ± 1.21. In addition, 10% of these women had no induction, 42% had dinoprostone, 48% had oxytocin induction and 55.5% had episiotomy. It was observed that the highest gravida ratio of women was 2 gravida with 41%. While 79% of the women did not have any abortus, 15% had 1 abortus. Mean prothrombin time, mean INR duration, and APTT duration were found to be 12.3 ± 0.56 (min), 0.98 ± 0.05 sec and 32 ± 3.4 sec, respectively. A decrease in hemoglobin, hematocrit, and platelet counts was observed between women's antepartum and postpartum periods. There was a statistically significant relationship between hemoglobin hematocrit and thrombocyte counts between the two groups. Significant correlation was found between postpartum hemoglobin and hematocrit values when fibrinogen was below 450 mg / dL. A statistically significant correlation was found between hemoglobin and hematocrit values and thus the amount of postpartum hemorrhage when fibrinogen was <450 mg / dl. (P <0.05). Significant correlation was found between hemoglobin and hematocrit values when calcium was below 8.8 mg / dl and statistically significant correlation was found between the decrease in these values and the amount of postpartum hemorrhage. (P <0.05). In the study, 48% of the newborns were girls and 52% were newborns. The average infant weight of these babies detected by prenatal ultrasound was 3279 ± 438.9 gr, while birth weights of these babies were 3356 ± 475.4 gr. Conclusion: It was concluded that the values of calcium (factor 4) and fibrinogen (factor 1) in coagulation cascade were negatively correlated with the decrease in postpartum hemogram values in pregnancies delivered with normal vaginal route and therefore postpartum hemorrhage. In addition, it was determined that the change in hemogram parameters after delivery was effective on the amount of postpartum hemorrhage. There is a need for wider studies to determine whether the need to routinely look at pre-natal calcium and fibrinogen levels in these outcomes is appropriate and / or cost-effective Key Words:Antepartum, Postpartum, Calcium, Fibrinogen, Hemorrhage