Thesis defense Ada Gillissen

Towards better prognostic and diagnostic strategies for Major Obstetric Haemorrhage

On 11 September 2019 (10: 00 hrs) Ada Gillissen  defended her PhD thesis 'Towards better prognostic and diagnostic strategies for Major Obstetric Haemorrhage' at the Leiden University.

Promotor: Prof JG van der Bom MD PhD
Copromotores: Prof TH van den Akker MD PhD and C Caram-Deelder PhD

Venue: Academy Building, Leiden University


Postpartum haemorrhage, in this thesis defined as blood loss above 1000mL within the first 24 hours after birth, remains a major cause of maternal morbidity and mortality with an incidence that seems to be increasing over the last decade. In this thesis we focussed on improvement of prognostic and diagnostic strategies for major obstetric haemorrhage, which may subsequently lead to a reduction of severe maternal morbidity, mortality and need for surgical interventions. In pursuit of this aim, research questions were posed corresponding to all three phases leading up to adverse outcome due to postpartum haemorrhage: pregnancy (prior to childbirth), early postpartum haemorrhage and persistent postpartum haemorrhage. In the first part of this thesis we focused on prediction of postpartum haemorrhage.Bleeding assessment tools were found to have no predictive value for postpartum haemorrhage. The change of coagulation parameters during the course of postpartum haemorrhage was described, and fibrinogen was found to be an early predictor of a worse outcome of postpartum haemorrhage. The association between fibrinogen measured by the Clauss method and ROTEM Fibtem was described in this thesis.