New approach to the risk variables for administration of fibrinogen in patients with postpartum hemorrhage by using cluster analysis.
OBJECTIVE
To analyze all the variables in women who received fibrinogen for postpartum hemorrhage (PPH) using hierarchical cluster analysis, to provide greater insight into the risk variables involved in these women.


METHODS
This retrospective study of women with at least 500 mL of bleeding at birth or during the postpartum period and treated with fibrinogen was conducted at the Department of Obstetrics and Gynecology, Atatürk University School of Medicine from January 2013 to January 2018. Data on the women were obtained from medical records and various risk variables were recorded and analyzed using hierarchical cluster analysis.


RESULTS
A total of 114 women with PPH were included in the study. Based on a dendrogram, three main clusters of similar quality variables were created: 1) gravida, parity, age, cervical/vaginal hematoma, laparotomy, hypogastric artery ligation, uterine artery embolization, uterine artery ligation, uterine atony, distance from outer center, lowest hemoglobin, preoperative platelets, endometritis, preoperative white blood cells; 2) lowest fibrinogen, highest fibrinogen, type of birth, placenta invasion anomaly, Bakri balloon tamponade, postpartum hysterectomy, preoperative activated partial thromboplastin time (APTT), preoperative international normalized ratio (INR), placental abruption, in-utero ex fetus; 3) postoperative APTT, postoperative INR, maternal mortality, erythrocyte transfusion, plasma transfusion, hospital stay time, disseminated intravascular coagulation/HELLP syndrome, highest hemoglobin, blood group, postoperative platelets, platelet transfusion, pre-eclampsia/eclampsia, fibrinogen extract.


CONCLUSION
According to the cluster analysis, we should keep fibrinogen extract in the foreground especially in the treatment of hemorrhage in patients with variable conditions. As a result, we can determine whether fibrinogen extract, which has a high economic cost, should be kept at each center. We can also direct which patient will be referred in accordance with the referral steps.
['Yilmaz|Emsal P T|EPT|', 'Celik|Yusuf|Y|', 'Topdagi|Yunus E|YE|', 'Guzel|Ali I|AI|', 'Al|Ragıp A|RA|']
D000037:Abruptio Placentae D000328:Adult D016913:Blood Component Transfusion D016000:Cluster Analysis D005260:Female D005340:Fibrinogen D006490:Hemostatics D006801:Humans D007044:Hysterectomy D008026:Ligation D010922:Placenta Diseases D006473:Postpartum Hemorrhage D011247:Pregnancy D012189:Retrospective Studies D055988:Uterine Artery D055357:Uterine Artery Embolization D014593:Uterine Inertia D055815:Young Adult
Fibrinogen Postpartum hemorrhage Cluster analysis Uterine atony Postpartum hysterectomy Maternal mortality Coagulopathy