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Incidence of Coagulopathy in Obstetric Hemorrhage
Abstract Number: T-18
Abstract Type: Original Research
Postpartum hemorrhage (PPH) affects 4-6% of pregnancies and is the second most common cause of maternal mortality in the U.S. Among deliveries complicated by PPH, we sought to determine the incidence of coagulopathy as well as the relationship between estimated blood loss (EBL) and other risk factors for coagulopathy.
We used the University of Colorado Perinatal Database (n=12,433) to identify patients with PPH between 2005 and 2009 (n=1901). Medical records were reviewed to confirm EBL and identify patients who developed coagulopathy. Coagulopathy was defined by documentation of the clinical diagnosis in the medical record with supporting laboratory studies. EBL was evaluated by categories; EBL 500-1500ml (mild), EBL 1501-3000ml (moderate) and EBL >3000ml (severe) and as a continuous variable in the regression model. Univariable and multivariable logistic regression models were used for analysis. The multivariable model included all factors that were significantly associated with coagulopathy in the univariable analyses.
In this cohort, 22 women (1.2%) developed coagulopathy. The relationship between EBL and coagulopathy is shown in Table 1 and demonstrates increasing incidence of coagulopathy across the blood loss groups(p<0.01). In the univariable analyses, older maternal age, lower gestational age at delivery, Asian or ‘other’ maternal race and cesarean delivery were associated with coagulopathy (p<0.03 for each variable); however, these associations became non-significant (P>0.05) in the multivariable regression. Blood loss remained associated with coagulopathy in the full model (P<0.01). We observed a greater than 5-fold increased risk of developing coagulopathy (OR=5.3, 95% CI 3.6-7.9) for every 1000ml increase in EBL.
The incidence of coagulopathy was 1.2% in our PPH cohort. We found a highly significant link between the severity of the blood loss and coagulopathy. Forty-three percent of patients losing >3000ml developed coagulopathy and this data suggests that, similar to trauma patients, obstetric patients may benefit from repletion of clotting factors prior to the loss of a total blood volume.