| Objective:To explore the changes of the coagulation and fibrinolysis function of cesarean section during perioperative period by detecting the related markers of coagulation and fibrinolysis combined with the conventional coagulation indexes.Methods:Sixty parturients admitted to the Second Affiliated Hospital of Kunming Medical University from August 2019 to December 2020 for elective cesarean delivery of 500mL≤intrauterine blood loss≤1000mL were included for comparison of blood coagulation function at different time points,and 20 parturients were included for comparison of fibrinolysis indexes at different time points.Collecting relevant information including patients with general clinical information(age,height,Pregestational weight,gestational weight gain,pregnancy days,hospitalization days,days in ICU,pregnancy related complications),the amount of blood loss during labor,bleeding reasons(placenta factor,anemic uterine contraction,birth canal factors and blood coagulation dysfunction),dosage of oxytocin,intraoperative blood transfusion rate,postpartum hemorrhage related complications,hysterectomy rate and mortality rate.Blood routine and clotting function been obtained respectively in the preoperative(T0),after surgery(T1),24 h after surgery(T2),at the same time,select 20 cases of maternal with postpartum hemorrhage to collect venous blood at different times including before operation(T0),after surgery(T1),24 h after surgery(T2)and the venous blood samples were centrifuged at low temperature(4℃)(2000rpf,10min)and then the upper serum was collected for detecting fibrinolytic indexes including Plasmin,PAP,PAI-1,F1+2 by ELASA method.Data collection and collation were carried out by Excel 2013.SPSS23.0 was used for statistical analysis.The measurement data conform to normal distribution(verified by Shapiro-Wilk test for normality analysis)and are expressed as mean±standard deviation(x±s).Measurement data that do not conform to the normal distribution are represented by the median(quaternary interval),M(IQR).Counting data is expressed as frequency and percentage,N(%).Routine blood,coagulation,and related fibrinolytic indicators were compared using one-way repeated-measure analysis of variance or Friedman’s test.Pearson correlation analysis was used for data consistent with normal distribution,while Spearman correlation analysis was used for data inconsistent with normal distribution.Graphpad Prism8.0 was used for data mapping and related statistical analysis.Results:1.In this study,the cause of postpartum hemorrhage was uterine weakness in 24 cases(40%),followed by placental factors in 7 cases(11.67%).2.In this study,the incidence of postpartum anemia was high,with 38 patients(63.33%)suffering from postpartum anemia.No coagulation dysfunction occurred,no hysterectomy was performed,and no death occurred.3.In this study,compared with T0,HB and PLT of 60 patients with postpartum hemorrhage were significantly reduced after surgery,the difference was statistically significant(P<0.001).The lowest Hb value was above 70g/L,failing to meet the requirements of blood transfusion,and the lowest PLT value was above 80×109/L.The blood coagulation indexes PT and APTT were prolonged after surgery,but they were within 1.5 times of the normal control value.The INR increased in the operation,and the difference was statistically significant(P<0.001),but the INR was not more than 1.5 times of the normal value,and the range of change was not clinically significant.TT value decreased after surgery,and the difference was statistically significant(P<0.001).The change range of TT value was small,and had no clinical reference significance.Both FIB and AT-Ⅲ were reduced after surgery,and the difference was statistically significant(P<0.001).Compared with T0,F1+2 decreased in 20 cases of postpartum hemorrhage after surgery,and the difference was statistically significant(P<0.001).Compared with T1,the PLT of 60 patients with postpartum hemorrhage increased at postpartum 24h,and the difference was statistically significant(P<0.001).PT and APTT began to shorten 24h after operation,and the difference was statistically significant(P<0.05).Both FIB and AT-Ⅲ increased 24h after surgery,and the difference was statistically significant(P<0.001).The changes of INR,TT and F1+2 24h after operation were not statistically significant.4.In this study,compared with T0,DD and FDPS of 60 patients with postpartum hemorrhage increased after surgery with statistical significance(P<0.05).PAP increased in 20 cases and the difference was statistically significant(P<0.05),while PAI-1 and PLA had no statistical significance.Compared with T1,DD and FDPS began to decrease again 24h after surgery,and the difference was statistically significant(P<0.05).The changes of PAP,PAI-1 and PLA in 20 parturient women were not statistically significant.5.In this study,56 of the 60 parturients had a lower FIB than that before operation,and 26 of them(46.43%)had a lower FIB than 1g/L.24 cases(42.86%)had a reduction of 1～2g/L.There were 6 patients(10.71%)with a reduction of 2～3g/L,and 1 parturient had a preoperative FIB value of 4.14g/L,and the FIB value was reduced to the lowest 1.94g/L after the operation.There was a moderately positive correlation between FIB and AT-Ⅲ AT the end of surgery(correlation coefficient 0.532,P<0.001).Conclusions:1.Routine coagulation indexes PT,APTT,FIB,DD,AT-Ⅲ and FDP combined with F1+2 and PAP were used to evaluate coagulation and fibrinolysis function of postcesarean women could be more comprehensive.2.Prenatal hypercoagulation was more obvious than postpartum hypercoagulation,and the activation of fibrinolytic system was more obvious postpartum than prepartum.3.Insufficient uterine contraction is the most important cause of postpartum hemorrhage in women undergoing cesarean section,and the incidence of postpartum anemia is high and it is of great significance to take effective measures to reduce bleeding in time.4.It is necessary to monitor the trend of FIB after delivery or when bleeding is difficult to control. |
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