Early low molecular weight heparin for postpartum hemorrhage in women with pre-eclampsia. Is it effective to prevent consumptive coagulopathy?

Background

Postpartum hemorrhage has been one of the most common cause of maternal morbidity and mortality. An association between pre-eclampsia (PE) and postpartum hemorrhage has been shown in previous studies. The aim of this study was to compare some characteristics of postpartum hemorrhage between women with and without PE.

Methods

Some characteristics of postpartum hemorrhage were compared between women with (n = 34) and without PE (n = 34). Majority of the cases underwent low molecular heparin administration at postpartum eighth hour, however, in cases who did not give satisfactory responses to blood product transfusions, to block suspected disseminated intravascular coagulation (DIC) secondary to the PE induced vascular injury, low molecular weight heparins were started within 2 h of postpartum hemorrhage. Some characteristics of cases with and without PE and with and without early low molecular weight heparin administration were compared.

Results

There were five cases who needed massive transfusions in group with PE, conversely, no case required massive transfusion in group without PE (p < .05), in these five cases prophylactic dose low molecular weight heparin was started within 2 h of postpartum period, these cases determined according to the changes in hematocrit, platelet, and fibrinogen levels with corresponding transfusions. Mean systolic and diastolic blood pressures were significantly higher in PE group. Highest lactate dehydrogenase (LDH) level during follow up was significantly higher in group with PE. Mean numbers of erythrocyte, thrombocyte, and fibrinogen transfusions were significantly higher in PE group. Duration of hospital stay was also significantly higher in group with PE.

Conclusions

Postpartum hemorrhage in women with PE may be resistant to blood product transfusions due to DIC and vicious cycle can be blocked by early low molecular weight heparin administration.