Association between placental growth factor levels in early onset preeclampsia with the occurrence of postpartum hemorrhage: A prospective cohort study

ObjectivesTo determine the association between PlGF (placental growth factor) estimation in early second trimester (22–24 weeks of gestation), with the occurrence of postpartum hemorrhage in pregnant women with early onset preeclampsia and whether the mode of delivery (cesarean or vaginal) has any association with increased risk of developing postpartum hemorrhage.Study designA prospective cohort study was conducted on 788 pregnant women with singleton pregnancies diagnosed with early onset preeclampsia between March 2009 and June 2011. Maternal serum PlGF level estimation was done between 22 and 24 weeks of gestation and a cut-off value of <122 pg/ml was determined by receiver operating characteristic (ROC) curve analysis for identifying those at risk of developing postpartum hemorrhage. Association between serum PlGF level <122 pg/ml and cesarean deliveries with the risk of developing postpartum hemorrhage was analyzed by logistic regression analysis and Odds ratio, which were computed. The results were considered statistically significant when P-value <0.05.Main outcome measuresProportion of study population developing postpartum hemorrhage.ResultsLogistic regression analysis showed the association of serum PlGF <122 pg/ml at 22–24 weeks (Odds ratio 8.9516; 95% CI, 5.0728–15.7963) and that of cesarean delivery (Odds ratio 2.4252; 95% CI, 1.4573–4.0360) with the risk of developing postpartum hemorrhage. Both the associations were found to be statistically significant.ConclusionMaternal serum PlGF level <122 pg/ml at 22–24 weeks of gestation and cesarean delivery are both strongly associated with the risk of developing postpartum hemorrhage in pregnant women with early onset preeclampsia.