Complications during pregnancy and childbirth are unfortunately a leading cause of death and disability among women of reproductive age in developing countries. Maternal death, as defined by the World Health Organization, is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause, related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. According to the World Health Organization (WHO), about 830 women die from pregnancy- or childbirth-related complications around the world every day. It was estimated that roughly 303,000 women died during or following pregnancy and childbirth in 2015. Postpartum hemorrhage (PPH) is the leading cause of maternal mortality. WHO statistics suggest that 60% of maternal deaths in developing countries are due to PPH, accounting for more than 100,000 maternal deaths per year. According to Dr. Korte, “This research aims to increase the understanding of predisposing factors for the development of PPH. At the same time, this should allow us to develop better tools to reduce or prevent the occurrence of PPH.”
Dr. Korte stated that the team conducted a monocentric, prospective study of prepartum activity of coagulation factors I, II, and XIII, which were analyzed in 1300 patients. Blood samples were drawn within 36 hours prior to onset of delivery. Correlations of coagulation factors with measured blood loss (MBL) were assessed by continuous outcome logistic regression. The investigators found that only factor XIII demonstrated a continuous, high correlation with MBL—for every unit increase of factor XIII, the odds ratio to remain below any cutoff for MBL was 1.011. Dr. Korte stated “Two models were used to measure the association of risk factors with maternal bleeding; the first included prepartum variables and the second studied pre- and post-partum variables. The association of factor XIII with blood loss was significant in both models. A hypothetical increase of factor XIII activity by 30% within the continuous model would result in a 38.9% increase in the probability that PPH would not occur. This effect was seen independently of the statistical model applied, the delivery mode, for any cutoff for MBL Thus, prepartum F XIII activity shows a robust and consistent influence throughout the whole spectrum of postpartum blood loss.”
Investigators concluded that there was a high correlation of prepartum factor XIII activity with MBL. Intervention studies are warranted to assess whether increasing factor XIII levels, in factor XIII low patients, will translate into reducing the volume of PPH, especially considering that it causes one-fourth of all maternal deaths worldwide.