The impact of prepartum factor XIII activity on postpartum blood loss

Abstract

Background: Postpartum hemorrhage (PPH), a major cause of maternal mortality, has several known risk factors but frequently occurs unexpectedly. PPH incidence and related maternal morbidity and mortality are rising worldwide. Objective: To evaluate the impact of defined prepartum blood coagulation parameters on postpartum blood loss. Methods: This single-center, prospective cohort study analyzed prepartum activities of coagulation factors II and XIII and fibrinogen levels in 1300 women. Blood samples were obtained at labor onset and analyzed only after the last patient had delivered, to prevent a potential treatment bias. Blood loss was quantified using a validated technique. The influence of coagulation factors on measured blood loss was assessed by continuous outcome logistic regression. Results: Prepartum factor XIII activity strongly influenced measured blood loss: every one unit (%) increase in prepartum factor XIII was associated with an odds ratio of 1.011 (95% confidence interval, 1.006-1.015; P