Frequency of Adverse Maternal and Neonatal Outcomes in Patients with Low Serum Fibrinogen Level and Placental Abruption

Abstract

Objective: To assess frequency of adverse maternal and neonatal outcomes in patients with low serum fibrinogen level and placental abruption.Place and duration: It was held in Gynecology Department Nishtar Hospital Multan from 12 November 2017 to 25 July 2018.Study Design: Case control retrospective study.Methodology: A total of 100 patients were included in this clinical trial and they were diagnosed with placental abruption. They were categorized on the basis of serum fibrinogen level into three groups; high fibrinogen group (400-600 mg/dL), normal fibrinogen group (300-400 mg/dL) and low fibrinogen group (<200 mg/dL). . The pregnant women with uterine rupture, wound of birth canal, placental accrete, placental praevia, HELLP syndrome, severe preeclampsia, monochorionic multiple pregnancies, major fetal anomalies and sign of intrauterine infection were excluded and all other women with single or more pregnancies were eligible for this clinical study. Computer software SPSS version 23.2 was used for entering and analyzing data. Frequency and percentage was calculated for baseline variables. Frequency and percentage was calculated for laboratory parameters. Frequencies and percentage was calculated for maternal and neonatal outcome variables like mode of delivery, PIH, GDM A, postpartum hemorrhage (PPH), postpartum anemia (PPA), FFP and RCC transfusion, ISTH DIC score, delay discharge from hospital, fetal death, Apgar score at 5 min <7, birth weight, still birth, umbilical artery pH < 7.00, neonatal gestational age and IUFG. ANOVA test was used to find frequency and percentage. P value was < 0.05 was considered to be significant.Result: 100 patients were included in this study and they were divided on the basis of serum fibrinogen level into three groups i.e. n=40 high Fibrinogen group (400-600 mg/dL), n=35 normal Fibrinogen group (300-400mg/dL) and n=25 low Fibrinogen group (<200mg/dL). All the data recorded from all three groups regarding PIH, GDM, FFP, RCC transfusion, ISTH DIC score, delayed discharge from hospital was insignificant. The differences were statistically significant of postpartum hemorrhage PPH (p=0.001) and postpartum anemia PPA (p=0.002). The data recorded from three groups regarding, Apgar score at 5 min <7, Birth weight (g), Umbilical artery pH < 7.00 and intrauterine fetal growth was statistically insignificant. The statistical differences observed in three groups were as; fetal death (p=0.047), still birth (p=0.016), and gestational age (weeks) (p= 0.001) respectively.Conclusion: It has been concluded that low serum fibrinogen level has higher frequency of adverse maternal and neonatal outcomes including postpartum hemorrhage (PPH), postpartum anemia (PPA), fetal death, small gestation age of neonates and still birth than normal and high serum fibrinogen level.

Keywords: Low serum fibrinogen, Placental Abruption, Maternal, Neonatal outcomes.