New approach to the risk variables for administration of fibrinogen in patients with postpartum hemorrhage by using cluster analysis

Objective To analyze all the variables in women who received fibrinogen for postpartum hemorrhage (PPH) using hierarchical cluster analysis, to provide greater insight into the risk variables involved in these women. Methods This retrospective study of women with at least 500 mL of bleeding at birth...

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Published in:	International journal of gynecology and obstetrics Vol. 152; no. 2; pp. 256 - 261
Main Authors:	Yilmaz, Emsal P. T., Celik, Yusuf, Topdagi, Yunus E., Guzel, Ali I., Al, Ragıp A.
Format:	Journal Article
Language:	English
Published:	United States 01-02-2021
Subjects:	Abruptio Placentae - epidemiology Adult Blood Component Transfusion Cluster Analysis Coagulopathy Female Fibrinogen Fibrinogen - administration & dosage Hemostatics - administration & dosage Humans Hysterectomy - statistics & numerical data Ligation Maternal mortality Placenta Diseases - epidemiology Postpartum hemorrhage Postpartum Hemorrhage - therapy Postpartum hysterectomy Pregnancy Retrospective Studies Uterine Artery Uterine Artery Embolization Uterine atony Uterine Inertia - epidemiology Young Adult Cluster analysis Maternal mortality Uterine atony Fibrinogen Postpartum hemorrhage Postpartum hysterectomy Coagulopathy
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Summary:	Objective To analyze all the variables in women who received fibrinogen for postpartum hemorrhage (PPH) using hierarchical cluster analysis, to provide greater insight into the risk variables involved in these women. Methods This retrospective study of women with at least 500 mL of bleeding at birth or during the postpartum period and treated with fibrinogen was conducted at the Department of Obstetrics and Gynecology, Atatürk University School of Medicine from January 2013 to January 2018. Data on the women were obtained from medical records and various risk variables were recorded and analyzed using hierarchical cluster analysis. Results A total of 114 women with PPH were included in the study. Based on a dendrogram, three main clusters of similar quality variables were created: 1) gravida, parity, age, cervical/vaginal hematoma, laparotomy, hypogastric artery ligation, uterine artery embolization, uterine artery ligation, uterine atony, distance from outer center, lowest hemoglobin, preoperative platelets, endometritis, preoperative white blood cells; 2) lowest fibrinogen, highest fibrinogen, type of birth, placenta invasion anomaly, Bakri balloon tamponade, postpartum hysterectomy, preoperative activated partial thromboplastin time (APTT), preoperative international normalized ratio (INR), placental abruption, in‐utero ex fetus; 3) postoperative APTT, postoperative INR, maternal mortality, erythrocyte transfusion, plasma transfusion, hospital stay time, disseminated intravascular coagulation/HELLP syndrome, highest hemoglobin, blood group, postoperative platelets, platelet transfusion, pre‐eclampsia/eclampsia, fibrinogen extract. Conclusion According to the cluster analysis, we should keep fibrinogen extract in the foreground especially in the treatment of hemorrhage in patients with variable conditions. As a result, we can determine whether fibrinogen extract, which has a high economic cost, should be kept at each center. We can also direct which patient will be referred in accordance with the referral steps. According to the cluster analysis, we should keep fibrinogen extract in the foreground especially in the treatment of hemorrhage in patients with variable conditions.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0020-7292 1879-3479
DOI:	10.1002/ijgo.13386