Preoperative Aspartate Aminotransferase-to-Platelet Ratio Index and Postpartum Haemorrhage after Caesarean Delivery
Abstract
Purpose: Postpartum haemorrhage (PPH) is a leading cause of maternal death, yet a simple preoperative marker of risk is lacking. The aspartate aminotransferase-to platelet ratio index (APRI) has been linked to adverse outcomes in non-hepatic surgery and in pregnancy complications. We examined whether it predicts PPH after caesarean delivery.
Materials and Methods: This retrospective case–control study reviewed caesarean deliveries at a tertiary hospital (2021–2022). Cases were 297 women who developed PPH (bleeding requiring transfusion and/or intervention for haemostasis); controls were 301 who needed neither. APRI was calculated from AST and platelet values obtained within 48 hours before delivery. Discrimination was assessed by ROC analysis in the a priori orientation (higher APRI hypothesised to indicate PPH), against haemoglobin, haematocrit, and platelet count, and by multivariable logistic regression adjusting for established risk factors.
Results: Preoperative haemoglobin and haematocrit were lower in the PPH group (10.4 vs 11.9 g/dL; 32.0% vs 35.0%; both p<0.001); platelets were marginally higher (249 vs 229 × 10⁹/L; p=0.003). APRI did not differ between groups (0.18 vs 0.19; p=0.22) and did not discriminate PPH (AUC 0.47, 95% CI 0.42–0.52; equivalent AUC 0.53 in the opposite orientation), whereas haemoglobin and haematocrit discriminated moderately (AUC 0.75 and 0.73; both p<0.001). After adjustment, APRI showed no independent association with PPH (adjusted OR 1.03, 95% CI 0.84–1.25), while low haemoglobin was the strongest predictor (adjusted OR 0.35 per 1-SD; p<0.001). APRI did not correlate with perioperative blood loss.
Conclusion: Preoperative APRI neither predicted nor correlated with PPH after caesarean delivery; low haemoglobin or haematocrit was more informative for risk stratification.
Keywords
postpartum haemorrhage, caesarean section, aspartate aminotransferase, platelet count, risk assessment
Supporting Institution
This study received no financial support from any public, commercial, or non-profit organization.
Ethical Statement
At the time the study was initiated, retrospective studies conducted at the study institution were reviewed and approved by the Tıpta Uzmanlık Eğitim Kurulu (TUEK; Medical Specialty Education Board), which served as the institutional approval mechanism for retrospective research. Accordingly, the study received TUEK approval (Decision No. 03, dated 26 February 2021). The study protocol was subsequently reviewed and approved by the Clinical Research Ethics Committee of Gaziosmanpaşa Training and Research Hospital, İstanbul, Türkiye (Approval No. 2026/146; 22 July 2026). The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. Owing to the retrospective design and the use of anonymized medical records, the requirement for informed consent was waived.
Thanks
The authors have no acknowledgments to declare.
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