Elevated Maternal Placental Protein 13 Serum Levels At Term Of Pregnancy In Postpartum Major Hemorrhage (> 1000 Mls). A Prospective Cohort Study

Problem: To compare placental protein 13 (PP13) levels in the serum of women with primary postpartum hemorrhage (PPH) with a control population.Methods: A prospective cohort study was conducted between May 2014 and May 2016 and included 435 pregnant women at term (38 weeks gestation) without any known risk factor and with normal labor. Multiples of median (MoM) were used to evaluate differences of the PP13 values between cases and controls. PP13 concentrations were adjusted for maternal and neonatal weight. Multivariable analysis was used to detect independent contribution of predictors of PPH.Results: Fifteen had a major PPH > 1000 mLs and represented the cases of the study. They were matched with 399 controls. Twenty-one patients who had a minor PPH (500-1000 mLs) were excluded. The mean observed rank in the PPH group was higher than that of controls (28.5 vs 13.5, P-value=.01). PP13 MoM values adjusted for maternal weight were higher than expected being 1.44 +/- 0.45 in PPH cases and 1.00 +/- 0.59 in controls (P-value .008). This difference was still significant even after adjustment for neonatal weight that represented a confounding variable.Conclusion: Higher PP13 levels are independently associated with major PPH > 1000 mLs.