Preoperative Aspartate Aminotransferase-to-Platelet Ratio Index and Postpartum Haemorrhage after Caesarean Delivery

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