Torrel VBH, Montelongo FJ, Galindo AJ, Reyes PMM, Herrera MBE, López BIM

Language: Spanish
References: 17
Page: 251-255
PDF size: 303.50 Kb.

ABSTRACT

Introduction: obstetric hemorrhage is one of the leading causes of maternal mortality worldwide, responsible for 27% of maternal deaths, a figure that rises to 30.9% in Mexico, mainly affecting young women. Rapid identification and management of this critical condition, particularly through multidisciplinary protocols such as the Maternal Code (Código Mater-Oro) and Severe Obstetric Emergency (ERI) implemented at Hospital General Las Américas, have significantly reduced in-hospital morbidity and mortality. In this context, fibrinogen, a key coagulation factor, emerges as a fundamental biomarker to assess the severity of hemorrhage, since levels below 200 mg/dL appear to be associated with bleeding that alters the clinical course and requires urgent interventions. Objective: to determine the correlation between serum fibrinogen levels and the severity of obstetric hemorrhage. Material and methods: a prospective, cross-sectional, descriptive, and analytical study was conducted on 31 patients with obstetric hemorrhage activated under the Maternal Code and admitted to the Intensive Care Unit. Patients with congenital or acquired bleeding disorders were excluded. Serum fibrinogen quantification was performed using a coagulometric method with the ACL-TOP305-CTS device, with results available in less than one hour. Descriptive and correlational statistical analyses using Spearman's test were applied to evaluate the relationship between fibrinogen levels and the estimated volume of blood loss. Results: the median age was 24.6 years (interquartile range [IQR] 16-40), and the median gestational age was 38.5 weeks (IQR 12-40). The leading cause of hemorrhage was uterine atony in 61% of cases. There were 12 cases of moderate hemorrhage, four severe, and five massive, with an incidence of extreme morbidity ("Near Miss") in 67% of cases. A 40% correlation was found between fibrinogen levels and blood volume loss, with a Spearman's ρ (r² = −0.697, p < 0.001). Conclusions: there is a strong positive correlation between low serum fibrinogen levels and the severity of obstetric hemorrhage, which correlates with a higher risk of hypovolemic shock. This study supports the value of fibrinogen as a crucial biomarker for early clinical decision-making in managing Maternal Code patients and reinforces the need for expanded multicenter research to consolidate protocols that optimize care and reduce associated maternal mortality.

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