Towards better prognostic and diagnostic strategies for major obstetric haemorrhage

Gillissen, A. (2019)

Doctoral Thesis

Postpartum haemorrhage, in this thesis defined as blood loss above 1000mL within the first 24 hours after birth, remains a major cause of maternal morbidity and mortality with an incidence that seems to be increasing over the last decade. In this thesis we focussed on improvement of prognostic and diagnostic strategies for major obstetric haemorrhage, which may subsequently lead to a reduction of severe maternal morbidity, mortality and need for surgical interventions. In pursuit of this aim, research questions were posed corresponding to all three phases leading up to adverse outcome due to postpartum haemorrhage: pregnancy (prior to childbirth), early postpartum haemorrhage and persistent postpartum haemorrhage. In the first part of this thesis we focused on prediction of postpartum haemorrhage.

Bleeding assessment tools were found to have no predictive value for postpartum haemorrhage. The change of coagulation parameters during the course of postpartum haemorrhage was described, and fibrinogen was found to be an early predictor of a worse outcome of postpartum haemorrhage. The association between fibrinogen measured by the Clauss method and ROTEM Fibtem was described in this thesis.

• Postpartum haemorrhage
• Prediction
• Point-of-care test
• Fibrinogen
• Thromboelastometry

• All authors: Gillissen, A.
• Supervisor: Bom, J.G. van der
• Co-supervisor: Akker, T.H. van den; Caram-Deelder, C.
• Committee: Lith, J.M.M. van; Juffermans, N.P.; Akker, E.S.A. van den
• Qualification: Doctor (dr.)
• Awarding Institution: Verloskunde, Medicine / Leiden University Medical Center (LUMC), Leiden
• Date: 2019-09-11
• ISBN (print): 9789463803915
• Sponsorship: Leiden University, the department of gynaecology and obstetrics of the Leiden University Medical Center; Sanquin; Raad van Bestuur Groene Hart Ziekenhuis; CSL Behring