RAISED D-DIMER LEVELS BEFORE DELIVERY AS AN EFFECTIVE PREDICTOR OF POSTPARTUM HEMORRHAGE.

Abstract

ABSTRACT: INTRODUCTION: The most common cause of maternal morbidity & death is postpartum hemorrhage (PPH). Secondary coagulopathy as a result of PPH or its treatment is frequently overestimated, & as a result, it goes untreated, potentially leading to even more severe PPH. Ddimer is a minor protein product that is detected in very small concentrations in the bloodstream due to endogenous fibrinolysis.DD level is elevated during pregnancy progressively. Its increased level can positively be correlated with venous thromboembolism. This has been investigated in previous researches but the observation of high DD levels at the time of admission for delivery & increased incidence of PPH in such women has not been investigated previously. PATIENTS & METHODS: 162 women with PPH who delivered at term vaginally or by caesarean section after uncomplicated pregnancies were included in the research. RESULTS: Among all women having marked elevation (>500ng/ml) of DD before delivery, 64.1% had developed PPH which was significant. While only 35.8%. of women with normal DD levels  had developed PPH.CONCLUSION: DD (D-Dimmer) levels tend to increase progressively during pregnancy but how it increases the incidence of postpartum hemorrhage in patient was not well known. DD level is one of the clinical parameter associated with coagulation & fibrinolysis. This research was conducted to conclude the association of raised DD (D-Dimmer) level at the time of delivery along with demographic factors of women with higher incidence of postpartum hemorrhage.