الفهرس 
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Abstract
important causes of maternal mortality whole over the world, especially in developing countries. About 140,000 women dying annually from this complication, and 1 every 4 minute.One of the hope of medical society to decrease incidence of PPH
Fibrinogen is an essential endogenous component of hemostasis, and its plasma concentration increases during pregnancy. Indeed, fibrinogen is the first coagulation factor to decrease to a critically low level during major blood loss and replacement with RBC
Coagulation plays an important role in postpartum hemostasis. Primary and especially secondary coagulation disorders are risk factors for PPH that have not been sufficiently evaluated.
fibrinogen concentrate (FC) is produced from human plasma but has viral inactivation and does not require cross-match or thawing before use. Use of RBC, FFP, and PC is associated with several transfusion-related complications. Recent studies recommended that with FC replacement, treatment can efficiently obtain hemostasis for PPH .
Signs and symptoms of PPH may initially include: an increased heart rate, feeling faint upon standing and an increased respiratory rate as more blood is lost the women may feel cold, their blood pressure may DROP (hypotension), and they may become unconscious
Treatments may include intravenous fluids, blood transfusions, and the medication ergotamine to cause further uterine contraction.
Our most important findings:
• the mean gestational age of the studied cases was 35.76 (±1.02 SD) with range from 34 to 37 week
• among the studied cases there were 20 (40%) primi-parous and 30 (60%) multiparous.
• among the studied cases there were 24 (48%) who had simple vaginal delivery, 10 (20%) who had instrumental vaginal delivery and 16 (32%) who had cesarean section.
• among the studied cases there were 18 (36%) with episiotomy, 2 (4%) with severe perineal tears and 27 (54%) with active management of third stage of labour and according to type of placental delivery, among the studied cases there were 34 (68%) with complete placental delivery and 16 (32%) with incomplete placental delivery.
• according to bleeding severity, that among the studied cases there were 32 (64%) with non-severe bleeding and 18 (36%) with severe bleeding.
• according to serum fibrinogen levels, the mean serum fibrinogen levels of the studied cases was 3.6 (±1.15 SD) with range from 1.5 to 5.8 g/l
• there was high statistically significant relation between bleeding severity and serum fibrinogen.
• according to Roc curve analysis for the use of serum fibrinogen levels to predict severity of bleeding, using serum fibrinogen levels at 3.95, it can predict PPH with AUC of 0.859, level of sensitivity 100%, specificity 71.9%, PPV 66.7%, NPV 100% and accuracy 82.0%.
• the cases with severe bleeding there were 2 (11.1%) with IUFD, 9 (50%) with macrosomic baby, 4 (22.2%) with placenta previa and 3 (16.7%) with twins.
• among the cases with severe bleeding there were 3 (16.7%) with birth canal lacerations, 6 (33.3%) with decreased serum fibrinogen level, 3 (16.7%) with prolonged labor, 4 (22.2%) with uterine atony and 2 (11.1%) with uterine rupture.
• among the cases with severe bleeding there were 2 (11.1%) who were treated by cryoprecipitate, 6 (33.3%) who were treated by fibrinogen concentrate and 10 (55.6%) who were treated by fresh frozen plasma
Conclusion
Fibrinogen is an important endogenous component of hemostasis, and its content in plasma rises throughout pregnancy. So, fibrinogen assays is required in the investigation of Postpartum haemorrhage. Decreased fibrinogen is a measure of the severity for the blood loss and a risk factor for development of severe Postpartum haemorrhage.
Fibrinogen concentrate (FC) is produced from human plasma but has viral inactivation and does not require cross-match or thawing before use.
Fibrinogen concentrate is a good choice of hemostatic therapy for ongoing bleeding in PPH