Assessment of Changes in Coagulation in Parturients with Preeclampsia Using Thromboelastography

Sharma, Shiv K.; Philip, John; Whitten, Charles W.; Padakandla, Udaya B.; Landers, Dennis F.

doi:10.1097/00000542-199902000-00009

Cited by 144 publications

(75 citation statements)

References 17 publications

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“…Elevated prepregnancy MA has been associated with an increased risk of miscarriage, 22 and strong correlations have also been shown between MA and low platelet counts in patients with severe preeclampsia. 23,24 However, there is limited data comparing changes in coagulation following fluid preloading in pregnant patients. Gorton and colleagues compared TEG changes following preloading with 500 mL gelofusine prior to CD with a group of patients who did not receive fluid preloading.…”

Section: Discussionmentioning

confidence: 99%

The effect of colloid and crystalloid preloading on thromboelastography prior to Cesarean delivery

Butwick

Carvalho

2007

Can J Anesth/J Can Anesth

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Purpose: Fluid preloading with colloids reduces hypotension after spinal anesthesia for Cesarean delivery more effectively than crystalloids. However, the effects of fluid preloading regimens on coagulation in pregnant patients remain unresolved. The aim of this study was to compare the effects on coagulation of fluid preloading with 6% hydroxyethyl starch (HES) and lactated Ringer's (LR) solution using thromboelastography (TEG) with kaolin-activated whole blood in healthy pregnant patients prior to spinal anesthesia for Cesarean delivery. Methods:After obtaining Ethics committee approval, 30 parturients were prospectively randomized prior to spinal anesthesia for elective Cesarean delivery to receive fluid preloading with either 1500 mL LR or 500 mL 6% HES over 30 min. Thromboelastography was performed immediately prior to and after fluid preloading. Standard TEG parameters were analyzed in terms of r time (min), k time (min), α angle (degrees) and maximum amplitude (mm).Results: Group HES had statistically significant longer reaction times (r) and clot formation times (k) after fluid loading compared to baseline values (P < 0.05 respectively), although these post-fluid loading TEG parameters remained within a normal reference range. No significant differences in TEG values were seen after preloading within the LR group. Conclusion:Fluid preloading with 500 mL 6% HES in healthy parturients produced mild coagulation effects, as measured with TEG, prior to spinal anesthesia for Cesarean delivery. No significant effects on coagulation with TEG were observed following preloading with 1500 mL LR.

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Section: Discussionmentioning

confidence: 99%

The effect of colloid and crystalloid preloading on thromboelastography prior to Cesarean delivery

Butwick

Carvalho

2007

Can J Anesth/J Can Anesth

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“…This is consistent with previous studies and reports. [5][6][7][20][21][22][23] In addition, platelet counts < 100 × 10 9 /L were found to be associated with abnormal coagulation test results. As clinicians would expect, both low platelet counts and abnormal coagulation were associated with an increased risk of adverse maternal outcome(s) or blood transfusion speci cally.…”

Section: Discussionmentioning

confidence: 94%

“…Several studies have supported the use of a platelet count threshold (100 × 10 9 /L) above which even women with severe preeclampsia are unlikely to have abnormalities in aPTT, INR, or serum brinogen. [5][6][7] This threshold has been endorsed by the Society of Obstetricians and Gynaecologists of Canada in the absence of placental abruption. 8 Standardized assessment and surveillance guidelines in British Columbia include the aforementioned laboratory assessments of coagulation, but recommend that aPTT, INR, and serum brinogen be measured in every woman with suspected or con rmed preeclampsia; this regimen of investigation is associated with reduced maternal risk.…”

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confidence: 99%

The Role of Platelet Counts in the Assessment of Inpatient Women With Preeclampsia

Laskin

Payne

Hutcheon

et al. 2011

Journal of Obstetrics and Gynaecology Canada

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Objective: Platelet count has been proposed as a screening test for generalized coagulopathy in women with preeclampsia We performed this study to determine the relationship between platelet counts and the risk of abnormal coagulation and adverse maternal outcomes in women with preeclampsia Methods:We used data from women in the PIERS (Pre-eclampsia Integrated Estimate of RiSk) database Abnormal coagulation was de ned as either an international normalized ratio result greater than and/or a serum brinogen level less than the BC Women's Hospital laboratory's pregnancy-speci c normal range The relationship between platelet counts and adverse maternal outcomes was explored using a logistic regression analysis The sensitivity, speci city, positive predictive value, and negative predictive value of platelet counts in identifying abnormal coagulation or adverse maternal outcomes were calculatedReslts: Abnormal coagulation occurred in 105 of 1405 eligible women (75%) The odds of having abnormal coagulation were increased for women with platelet counts < 50 × 10 9 /L (OR 778; 95% CI 336 to 1803) and between 50 and 99 × 10 9 /L (OR 269; 95% CI 144 to 501) compared with women who had platelet counts above 150 × 10 9 /L Platelet counts < 100 × 10 9 /L were associated with signi cantly increased odds of adverse maternal outcomes, most speci cally blood transfusion A platelet count of < 100 × 10 9 /L had good speci city in identifying abnormal coagulation and adverse maternal outcomes (92% [95% CI 91% to 94%] and 92% [95% CI 91% to 94%], respectively), but poor sensitivity (22% [95% CI 15% to 31%] and 16% [95% CI 11% to 23%], respectively) Conclsion: A platelet count < 100 × 10 9 /L is associated with an increased risk of abnormal coagulation and maternal adverse outcomes in women with preeclampsia However, the platelet count should not be used in isolation to guide care because of its poor sensitivity Whether or not a platelet count is normal should not be used to determine whether further coagulation tests are needed Résltats : Une coagulation anormale s'est manifestée chez 105 des 1 405 femmes admissibles (7,5 %) Les risques de présenter une coagulation anormale étaient accrus chez les femmes qui comptaient des numérations plaquettaires < 50 × 10 9 /l (RC,7,78; IC à 95 %,3,03) The Role of Platelet Conts in the Assessment of Inpatient Women With Preeclampsia avec les femmes qui comptaient des numérations plaquettaires se situant au-delà de 150 × 10 9 /l Les numérations plaquettaires < 100 × 10 9 /l ont été associées à une hausse signi cative des risques de connaître des issues maternelles indésirables, plus particulièrement une transfusion sanguine Une numération plaquettaire < 100 × 10 9 /l présentait une bonne spéci cité pour ce qui est de l'identi cation d

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“…16,17 Some investigators are exploring the use of thromboelastography (TEG) in the settings of thrombocytopenia and preeclampsia. 18,19 Whether or not TEG will provide useful information to obstetric anesthesiologists remains unknown.…”

Section: Patient Education and Consent For Labour Analgesiamentioning

confidence: 99%

Obstetric anesthesia practice in Canada

Breen

McNeil

Dierenfield

2000

Can J Anesth/J Can Anesth

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Purpose: To describe obstetric anesthesia in Canada as practiced in 1997: to identify practices at variance with the literature and the opinions of experts: and to identify questions for future research.Methods: In 1997, a detailed postal questionnaire asking about the practice of obstetric anesthesia was mailed to all 1,539 specialist anesthesiologist members of the Canadian Anaesthetists' Society residing in Canada. Nonresponders were mailed a second questionnaire three months later.Results: There were 865 completed questionnaires returned for analysis (56.2%). Of these, 522 anesthesiologists practiced obstetric anesthesia (60.3%). The data were subdivided into those from anesthesiologists with a full or part-time university based practice (40.1%) and those from a community based practice (59.9%). University based and community-based anesthesiologists have very similar patterns of practice. Specific areas where anesthesia practice was different from current recommendations included: (1) information provided when obtaining consent for labour epidural analgesia, (2) use of opioids and local anesthetics for initiation of epidural analgesia, (3) use of coagulation testing in preeclampsia, (4) the common use of cutting spinal needles, (5) use of neuraxial morphine and nonsteroidal anti-inflammatory agents after Cesarean deliveries, (6) optimal treatment of neuraxial opioid side effects, (7) when to insert an endotracheal tube for general anesthesia after delivery, and (8) withdrawing epidural catheters through epidural needles.Conclusions: This survey presents reference data on the practice of obstetric anesthesia in Canada in 1997. Anesthesiologists with university affiliation have very similar practices to those without university affiliations.Objectif: Décrire l'anesthésie obstétricale pratiquée au Canada en 1997; identifier les pratiques qui diffèrent des pratiques documentées et des opinions d'experts et proposer des sujets de recherches ultérieures.Méthode : En 1997, un questionnaire détaillé sur la pratique de l'anesthésie obstétricale a été posté aux 1 539 anesthésiologistes membres de la Société canadienne des anesthésiologistes résidant au Canada. Trois mois plus tard, un second questionnaire a été posté à ceux qui n'avaient pas encore répondu.Résultats : Il y a eu 865 questionnaires remplis et analysés (56,2 %). De ce nombre, 522 provenaient d'anesthé-siologistes pratiquant l'anesthésie obstétricale (60,3 %). Les données ont été subdivisées selon le lieu de pratique, en milieu universitaire à temps complet ou partiel (40,1 %) ou en d'autres centres (59,9 %). Les modèles de pratique étaient très similaires. Certaines activités spécifiques différaient des recommandations courantes : 1) l'information fournie pour obtenir le consentement à l'analgésie épidurale pendant le travail, 2) l'usage d'opioïdes et d'anesthésiques locaux pour amorcer l'analgésie épidurale, 3) l'utilisation d'épreuve de coagulation en préé-clampsie, 4) l'usage courant d'aiguilles rachidiennes tranchantes, 5) l'administration neuraxiale...

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Assessment of Changes in Coagulation in Parturients with Preeclampsia Using Thromboelastography

Abstract: This study shows that severe preeclamptic women with a platelet count <100,000/mm3 are hypocoagulable when compared to healthy pregnant women and other preeclamptic women.

Cited by 144 publications

References 17 publications

The effect of colloid and crystalloid preloading on thromboelastography prior to Cesarean delivery

The effect of colloid and crystalloid preloading on thromboelastography prior to Cesarean delivery

The Role of Platelet Counts in the Assessment of Inpatient Women With Preeclampsia

Obstetric anesthesia practice in Canada

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