Algorithm for classifying the underlying pathologies in postpartum hemorrhage using bleeding rate, fibrinogen, and fibrin/fibrinogen degradation products: a case series study.
13 affiliations
- 1Department of Obstetrics and Gynecology, National Hospital Organization, Okayama Medical Center, 1711-1 Tamasu, Kita Ward, Okayama, 701-1192, Japan. [email protected].
- 2Department of Obstetrics and Gynecology, National Hospital Organization, Okayama Medical Center, 1711-1 Tamasu, Kita Ward, Okayama, 701-1192, Japan.
- 3Medical Data Labo, 289-48 Yamasaki, Naka Ward, Okayama, 703-8267, Japan.
- 4Department of Obstetrics and Gynecology, National Hospital Organization, Nagasaki Medical Center, 2-1001-1 Kubara, Omura, 856-0835, Japan.
- 5Department of Obstetrics and Gynecology, National Hospital Organization, Saga Hospital, 1-20-1 Hinode, Saga, 849-8577, Japan.
- 6Department of Obstetrics and Gynecology, National Hospital Organization, Kyoto Medical Center, 1-1 Fukasakumukaihata, Kyoto, 612-8555, Japan.
- 7Takabatake Women's Clinic, 4-18 Ogimachi, Daito, 574-0033, Japan.
- 8Department of Obstetrics and Gynecology, National Hospital Organization, Kure Medical Center, 3-1 Aoyama, Kure, 737-0023, Japan.
- 9Department of Obstetrics and Gynecology, National Hospital Organization, Higashihiroshima Medical Center, 513 Saijochojike, Higashihiroshima, 739-0041, Japan.
- 10Division of Obstetrics and Perinatal Care for Central Hiroshima, Hiroshima University Hospital, 1-2-3 Kasumi, Minami Ward, Hiroshima, 734-8551, Japan.
- 11Department of Obstetrics and Gynecology, National Hospital Organization, Mie Chuo Medical Center, 2158-5 Hisaimyojincho, Tsu, 514-1101, Japan.
- 12Department of Obstetrics and Gynecology, National Hospital Organization, Shikoku Medical Center for Children and Adults, 2-1-1 Senyucho, Zentsuji, 765-8507, Japan.
- 13Department of Obstetrics and Gynecology, National Hospital Organization, Kokura Medical Center, 10-1 Harugaoka, Kokuraminami Ward, Kitakyushu, 802-8533, Japan.
Abstract
Background
Understanding patients' underlying pathologies is essential for appropriate treatment during postpartum hemorrhage (PPH) management. The objective of this study is to develop an algorithm that quantitatively classifies the underlying pathologies in PPH using clinical parameters.Methods
A multicenter case series study involving nine perinatal centers in Japan was conducted on patients with severe PPH (blood loss > 2000 mL) excluding placental abruption, and placental abruption irrespective of blood loss spanning August 2020 to June 2024. The primary outcome was the development of an algorithm for classifying the underlying pathologies in PPH, based on bleeding rate, fibrinogen, and fibrin/fibrinogen degradation products (FDP). We used collected data to develop an algorithm by which cases with abnormally high bleeding rate (≥ 61 mL/min) were classified as whole blood loss with high bleeding rate (WBLH). Of cases with bleeding rate < 61 mL/min, those with fibrinogen ≥ 237 mg/dL were classified as non-coagulopathy (NCP). Of cases with fibrinogen < 237 mg/dL, those with FDP < 2 mg/dL and FDP ≥ 2 mg/dL were classified as whole blood loss with low bleeding rate (WBLL) and coagulation factor consumption (CFC), respectively. In CFC cases, a predictive formula distinguished between disseminated intravascular coagulation (DIC) from locally initiated and progressive consumptive coagulopathy for hemostasis (LIPC). We used the Mann-Whitney test and Fisher's exact test for the statistical analysis.Results
Among 171 participants, comprising 131 severe PPH cases and 40 placental abruption cases, the algorithm classified cases into WBLH (n = 9), NCP (n = 88), WBLL (n = 12), and CFC (n = 62). Of the CFC cases, 3 had DIC and 59 had LIPC. FDP levels did not differ between WBLH (median, 1.19 mg/dL) and WBLL (median, 0.91 mg/dL). Hemoglobin (median, 6.3 g/dL) in WBLL and fibrinogen (median, 168.5 mg/dL) in CFC were significantly lower than for the other three categories (P < 0.05). Coagulation-fibrinolytic activation in DIC was significantly increased compared with LIPC cases.Conclusions
Our algorithm, using bleeding rate, fibrinogen, and FDP as clinical parameters, classified PPH cases into four underlying pathologies. This pilot study provides a foundation for pathophysiology-based clinical management of PPH.
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BibTeX
@article{tada2026algorithm,
title = {{Algorithm for classifying the underlying pathologies in postpartum hemorrhage using bleeding rate, fibrinogen, and fibrin/fibrinogen degradation products: a case series study.}},
author = {Katsuhiko Tada and Yasunari Miyagi and Ichiro Yasuhi and Keisuke Tsumura and Ikuko Emoto and Maiko Sagawa and Norifumi Tanaka and Kyohei Yamaguchi and Kazuhisa Maeda and Kosuke Kawakami and Collaborative Research in National Hospital Organization Network Pediatric and Perinatal Group},
journal = {BMC pregnancy and childbirth},
year = {2026},
month = aug,
doi = {10.1186/s12884-026-09762-2},
url = {https://europepmc.org/article/MED/42958111},
note = {CC BY},
}
RIS
TY - JOUR
TI - Algorithm for classifying the underlying pathologies in postpartum hemorrhage using bleeding rate, fibrinogen, and fibrin/fibrinogen degradation products: a case series study.
AU - Katsuhiko Tada
AU - Yasunari Miyagi
AU - Ichiro Yasuhi
AU - Keisuke Tsumura
AU - Ikuko Emoto
AU - Maiko Sagawa
AU - Norifumi Tanaka
AU - Kyohei Yamaguchi
AU - Kazuhisa Maeda
AU - Kosuke Kawakami
AU - Collaborative Research in National Hospital Organization Network Pediatric and Perinatal Group
PY - 2026
DA - 2026/08/03
JO - BMC pregnancy and childbirth
DO - 10.1186/s12884-026-09762-2
UR - https://europepmc.org/article/MED/42958111
AB - Background Understanding patients' underlying pathologies is essential for appropriate treatment during postpartum hemorrhage (PPH) management. The objective of this study is to develop an algorithm that quantitatively classifies the underlying pathologies in PPH using clinical parameters.Methods A multicenter case series study involving nine perinatal centers in Japan was conducted on patients with severe PPH (blood loss > 2000 mL) excluding placental abruption, and placental abruption irrespective of blood loss spanning August 2020 to June 2024. The primary outcome was the development of an algorithm for classifying the underlying pathologies in PPH, based on bleeding rate, fibrinogen, and fibrin/fibrinogen degradation products (FDP). We used collected data to develop an algorithm by which cases with abnormally high bleeding rate (≥ 61 mL/min) were classified as whole blood loss with high bleeding rate (WBLH). Of cases with bleeding rate < 61 mL/min, those with fibrinogen ≥ 237 mg/dL were classified as non-coagulopathy (NCP). Of cases with fibrinogen < 237 mg/dL, those with FDP < 2 mg/dL and FDP ≥ 2 mg/dL were classified as whole blood loss with low bleeding rate (WBLL) and coagulation factor consumption (CFC), respectively. In CFC cases, a predictive formula distinguished between disseminated intravascular coagulation (DIC) from locally initiated and progressive consumptive coagulopathy for hemostasis (LIPC). We used the Mann-Whitney test and Fisher's exact test for the statistical analysis.Results Among 171 participants, comprising 131 severe PPH cases and 40 placental abruption cases, the algorithm classified cases into WBLH (n = 9), NCP (n = 88), WBLL (n = 12), and CFC (n = 62). Of the CFC cases, 3 had DIC and 59 had LIPC. FDP levels did not differ between WBLH (median, 1.19 mg/dL) and WBLL (median, 0.91 mg/dL). Hemoglobin (median, 6.3 g/dL) in WBLL and fibrinogen (median, 168.5 mg/dL) in CFC were significantly lower than for the other three categories (P < 0.05). Coagulation-fibrinolytic activation in DIC was significantly increased compared with LIPC cases.Conclusions Our algorithm, using bleeding rate, fibrinogen, and FDP as clinical parameters, classified PPH cases into four underlying pathologies. This pilot study provides a foundation for pathophysiology-based clinical management of PPH.
SN - 1471-2393
ER -