Skip to main content

Advertisement

SpringerLink
Log in

Effect of hypofibrinogenemia on obstetrical disseminated intravascular coagulation in Japan in 2018: a multicenter retrospective cohort study

  • Original Article
  • Published:
International Journal of Hematology Aims and scope Submit manuscript

Abstract

Japanese obstetrical hemorrhage recommendations state that not only pregnant women with an obstetrical disseminated intravascular coagulation (DIC) score ≥ 8 points but also those with fibrinogen levels ≤ 1.5 g/L have a high risk of maternal death and warrant blood transfusion. Our aim was to demonstrate the potential of fibrinogen levels ≤ 1.5 g/L as predictors of a Japanese obstetrical DIC score of ≥ 8. We included 595 participants with blood loss ≥ 1000 mL during vaginal delivery or ≥ 2000 mL during cesarean delivery. The frequency and volume of red blood cell (RBC), fresh-frozen plasma, platelet concentrate (PC), and fibrinogen administration in women with a DIC score of ≥ 8 and fibrinogen levels of ≤ 1.5 g/L were significantly higher than controls (P < 0.0001). Multivariate analysis demonstrated that a score of ≥ 3 was associated with RBC or fibrinogen administration and a score of ≥ 5 was associated with PC transfusion. Fibrinogen levels ≤ 1.89 g/L and ≤ 2.44 g/L were associated with PC transfusion and fibrinogen administration, respectively. Fibrinogen levels ≤ 1.5 g/L may have similar potential to a DIC score of ≥ 8 points for detecting obstetrical DIC in Japan.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

APTT:

Activated partial thromboplastin time

CI:

Confidence interval

DIC:

Disseminated intravascular coagulation

FDP:

Fibrin-fibrinogen degradation product

FFP:

Fresh-frozen plasma

OR:

Odds ratio

PC:

Platelet concentrate

PT:

Prothrombin time

RBC:

Red blood concentrate

SI:

Shock index

References

  1. Minakami H, Maeda T, Fujii T, Hamada H, Iitsuka Y, Itakura A, et al. Guidelines for obstetrical practice in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG). 2014 edition. J Obstet Gynaecol Res. 2014;40(6):1469–99. https://doi.org/10.1111/jog.12419.

    Article  PubMed  Google Scholar 

  2. Guidelines for obstetrical practice in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG). 2020 edition. in Japanese.

  3. Hasegawa J, Katsuragi S, Tanaka H, Kurasaki A, Nakamura M, Murakoshi T, et al. Decline in maternal death due to obstetric haemorrhage between 2010 and 2017 in Japan. Sci Rep. 2019;9(1):11026. https://doi.org/10.1038/s41598-019-47378-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. The Japan Association of Obstetricians and Gynecologists (JAOG) and the Japan Maternal Death Exploratory Committee (JMDEC). (ed.) Recommendations for saving mother, (Tokyo, 2018). In Japanese.

  5. Kobayashi T. Obstetrical disseminated intravascular coagulation score. J Obstet Gynaecol Res. 2014;40(6):1500–6. https://doi.org/10.1111/jog.12426.

    Article  PubMed  Google Scholar 

  6. Terao T, Maki M, Ikenoue T. A prospective study in 38 patients with abruptio placentae of 70 cases complicated by DIC. Asia Oceania J Obstet Gynaecol. 1987;13(1):1–13. https://doi.org/10.1111/j.1447-0756.1987.tb00001.x.

    Article  CAS  PubMed  Google Scholar 

  7. Wang L, Matsunaga S, Mikami Y, Takai Y, Terui K, Seki H. Pre-delivery fibrinogen predicts adverse maternal or neonatal outcomes in patients with placental abruption. J Obstet Gynaecol Res. 2016;42(7):796–802. https://doi.org/10.1111/jog.12988.

    Article  CAS  PubMed  Google Scholar 

  8. Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics, 24 ed. Section 11. Chapter 41. Obstetrical Hemorrhage. Placental Abruption. Consumptive Coagulopathy. New York, USA: McGraw-Hill Education. 2014.

  9. Miyata S, Itakura A, Ueda Y, Usui A, Okita Y, Oonishi Y, et al. Transfusion guidelines for patients with massive bleeding. J Transfus Cell Ther. 2019;65(1):21–92. https://doi.org/10.3925/jjtc.65.21 (In Japanese).

    Article  Google Scholar 

  10. Takeda S, Makino S, Takeda J, Kanayama N, Kubo T, Nakai A, et al. Japanese clinical practice guide for critical obstetrical hemorrhage (2017 revision). J Obstet Gynaecol Res. 2017;43(10):1517–21. https://doi.org/10.1111/jog.13417.

    Article  PubMed  Google Scholar 

  11. Kobayashi T, Terao T, Maki M, Ikenoue T. Diagnosis and management of acute obstetrical DIC. Semin Thromb Hemost. 2001;27(2):161–7. https://doi.org/10.1055/s-2001-14076.

    Article  CAS  PubMed  Google Scholar 

  12. Maki M, Terao T, Ikenoue T, Takemura T, Sekiba K, Shirakawa K, et al. Clinical evaluation of antithrombin III concentrate (BI 6.013) for disseminated intravascular coagulation in obstetrics Well-controlled multicenter trial. Gynecol Obstet Invest. 1987;23(4):230–40. https://doi.org/10.1159/000298866.

    Article  CAS  PubMed  Google Scholar 

  13. Kobayashi T, Kajiki M, Nihashi K, Honda G. Surveillance of the safety and efficacy of recombinant human soluble thrombomodulin in patients with obstetrical disseminated intravascular coagulation. Thromb Res. 2017;159:109–15. https://doi.org/10.1016/j.thromres.2017.08.017.

    Article  CAS  PubMed  Google Scholar 

  14. Yoshihara M, Uno K, Tano S, Mayama M, Ukai M, Kondo S, et al. The efficacy of recombinant human soluble thrombomodulin for obstetric disseminated intravascular coagulation: a retrospective study. Crit Care. 2015;19:369. https://doi.org/10.1186/s13054-015-1086-3.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Tanaka H, Katsuragi S, Osato K, Hasegawa J, Nakata M, Murakoshi T, et al. Efficacy of transfusion with fresh-frozen plasma:red blood cell concentrate ratio of 1 or more for amniotic fluid embolism with coagulopathy: a case-control study. Transfusion. 2016;56(12):3042–6. https://doi.org/10.1111/trf.13856.

    Article  PubMed  Google Scholar 

  16. Kobayashi T, Nakabayashi M, Yoshioka A, Maeda M, Ikenoue T. Recombinant activated factor VII (rFVIIa/NovoSeven®) in the management of severe postpartum haemorrhage: initial report of a multicentre case series in Japan. Int J Hematol. 2012;95(1):57–63. https://doi.org/10.1007/s12185-011-0974-9.

    Article  CAS  PubMed  Google Scholar 

  17. Murakami M, Kobayashi T, Kubo T, Hata T, Takeda S, Masuzaki H. Experience with recombinant activated factor VII for severe post-partum hemorrhage in Japan, investigated by Perinatology Committee, Japan Society of Obstetrics and Gynecology. J Obstet Gynaecol Res. 2015;41(8):1161–8. https://doi.org/10.1111/jog.12712.

    Article  CAS  PubMed  Google Scholar 

  18. Asakura H. Classifying types of disseminated intravascular coagulation: clinical and animal models. J Intensive Care. 2014;2(1):20. https://doi.org/10.1186/2052-0492-2-20.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M, Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH). Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001;86(5):1327–30.

    Article  CAS  Google Scholar 

  20. Erez O, Novack L, Beer-Weisel R, Dukler D, Press F, Zlotnik A, et al. DIC score in pregnant women-a population based modification of the International Society on Thrombosis and Hemostasis score. PLoS ONE. 2014;9(4):e93240. https://doi.org/10.1371/journal.pone.0093240.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Rabinovich A, Abdul-Kadir R, Thachil J, Iba T, Othman M, Erez O. DIC in obstetrics: Diagnostic score, highlights in management, and international registry-communication from the DIC and Women’s Health SSCs of the International Society of Thrombosis and Haemostasis. J Thromb Haemost. 2019;17(9):1562–6. https://doi.org/10.1111/jth.14523.

    Article  PubMed  Google Scholar 

  22. Matsunaga S, Takai Y, Seki H. Fibrinogen for the management of critical obstetric hemorrhage. J Obstet Gynaecol Res. 2019;45(1):13–21. https://doi.org/10.1111/jog.13788.

    Article  CAS  PubMed  Google Scholar 

  23. Makino S, Takeda S, Kobayashi T, Murakami M, Kubo T, Hata T, et al. National survey of fibrinogen concentrate usage for post-partum hemorrhage in Japan: investigated by the Perinatology Committee, Japan Society of Obstetrics and Gynecology. J Obstet Gynaecol Res. 2015;41(8):1155–60. https://doi.org/10.1111/jog.12708.

    Article  PubMed  Google Scholar 

  24. Matsunaga S, Takai Y, Nakamura E, Era S, Ono Y, Yamamoto K, et al. The clinical efficacy of fibrinogen concentrate in massive obstetric haemorrhage with hypofibrinogenaemia. Sci Rep. 2017;7:46749. https://doi.org/10.1038/srep46749.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Enago (www.enago.jp) for the English language review.

Funding

The first author received funding from Japan Blood Products Organization.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Kita-ku N15 W7, Sapporo, 060-8638, Japan

    Mamoru Morikawa

  2. Department of Obstetrics and Gynecology, Center for Maternal, Fetal, and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan

    Shigetaka Matsunaga

  3. Department of Obstetrics and Gynecology, Juntendo University Urayasu Hospital, Chiba, Japan

    Shintaro Makino

  4. Department of Obstetrics and Gynecology, Aiiku Maternal and Child Health Center, Aiiku Hospital, Tokyo, Japan

    Yoshiharu Takeda & Tomoko Adachi

  5. Department of Obstetrics and Gynecology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

    Hironobu Hyoudo

  6. Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan

    Masafumi Nii

  7. Department of Obstetrics and Gynecology, Hamamatsu Medical Center, Hamamatsu, Japan

    Mariko Serizawa & Takao Kobayashi

  8. Department of Obstetrics and Gynecology, Juntendo University Graduate School of Medicine, Tokyo, Japan

    Atsuo Itakura

  9. The Japan Society of Obstetrical, Gynecological and Neonatal Hematology, Kitakyushu, Japan

    Mamoru Morikawa, Shigetaka Matsunaga, Shintaro Makino, Yoshiharu Takeda, Hironobu Hyoudo, Masafumi Nii, Mariko Serizawa, Atsuo Itakura, Tomoko Adachi & Takao Kobayashi

Authors
  1. Mamoru Morikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shigetaka Matsunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shintaro Makino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshiharu Takeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hironobu Hyoudo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masafumi Nii
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mariko Serizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Atsuo Itakura
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tomoko Adachi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takao Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MM wrote the manuscript and researched data. MM, SM, SM, YT, HH, MN, and MS collected data. AI, TA, and TK contributed to the discussion and reviewed or edited the manuscript.

Corresponding author

Correspondence to Mamoru Morikawa.

Ethics declarations

Conflict of interest

None of the authors have any conflicts of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morikawa, M., Matsunaga, S., Makino, S. et al. Effect of hypofibrinogenemia on obstetrical disseminated intravascular coagulation in Japan in 2018: a multicenter retrospective cohort study. Int J Hematol 114, 18–34 (2021). https://doi.org/10.1007/s12185-021-03119-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12185-021-03119-5

Keywords

Search

Navigation