Coagulation Monitoring in the Obstetric Patient

Ce, Orlikowski; Da, Rocke

doi:10.1097/00004311-199400000-00013

Cited by 18 publications

(10 citation statements)

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“…They are performed on whole blood and provide information on the time taken for first fibrin strand formation, the velocity of clot formation, the strength of the formed clot, and fibrinolysis (Table 2). They have been used to demonstrate the hypercoagulable state of pregnancy [27][28][29] and the resolution to nonpregnant values in the puerperium. 30,31 There are numerous case reports of the use of TEG and ROTEM to guide replacement of blood components in the management of PPH 32,33 and studies have confirmed a reduction in blood loss and associated transfusion of blood products with the use of these tests in other settings.…”

Section: Point-of-care Testsmentioning

confidence: 99%

How I treat postpartum hemorrhage

Pavord

Maybury

2015

Blood

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Worldwide, ∼800 women die every day from preventable causes related to pregnancy or childbirth. The single most common cause is severe bleeding, which can kill a healthy woman within hours if care is substandard or delayed. Improved antenatal practices have led to the early identification of at-risk women and modern technology and new techniques have enabled effective management strategies so that now, in the western world, most of the morbidity and mortality arises from those cases which occur unexpectedly and could not have been predicted. Prompt and effective management and multidisciplinary involvement is paramount to save the lives of these women. We use a case report to illustrate and discuss the main elements of management of this condition.

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Section: Point-of-care Testsmentioning

confidence: 99%

How I treat postpartum hemorrhage

Pavord

Maybury

2015

Blood

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“…The tests consist of platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), with plasma fibrinogen levels also routinely determined in many centres. 12152526 Platelet count provides a measure of platelet concentration but not function. PT measures the extrinsic and common coagulation pathways, and is sensitive to levels of coagulation factors (F) II, V, VII, and X, whereas aPTT assesses coagulation via the intrinsic and common pathways and is sensitive to all coagulation factors except FVII and FXIII.…”

Section: Standard Coagulation Tests; Assessment Of Bleeding Risk In Omentioning

confidence: 99%

“…PT measures the extrinsic and common coagulation pathways, and is sensitive to levels of coagulation factors (F) II, V, VII, and X, whereas aPTT assesses coagulation via the intrinsic and common pathways and is sensitive to all coagulation factors except FVII and FXIII. 2527 The aPTT is shorter in pregnancy because of the raised FVIII and so is relatively insensitive to haemostatic impairment. Both the PT and aPTT are relatively insensitive to plasma fibrinogen levels, which are typically measured indirectly using the Clauss assay.…”

Section: Standard Coagulation Tests; Assessment Of Bleeding Risk In Omentioning

confidence: 99%

“…A comprehensive assessment of bleeding history and medication history is considered more accurate and cost-effective. 253033–35 …”

Section: Standard Coagulation Tests; Assessment Of Bleeding Risk In Omentioning

confidence: 99%

“…TEG ® 2583 and ROTEM ® 29 can be used to demonstrate hypercoagulability in pregnancy. A case-matched study involving INTEM, EXTEM, and FIBTEM testing of 120 women, either pregnant and undergoing elective Caesarean section or non-pregnant and undergoing elective surgery, found that for all tests, the time of coagulation (CT and CFT) was reduced, and clot firmness (MCF) was increased, in the pregnant group.…”

Section: Obstetric Coagulation Monitoring Using Thrombelastography Anmentioning

confidence: 99%

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Haemostatic monitoring during postpartum haemorrhage and implications for management

Solomon

Collis

Collins

2012

British Journal of Anaesthesia

186

162

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SummaryPostpartum haemorrhage (PPH) is a major risk factor for maternal morbidity and mortality. PPH has numerous causative factors, which makes its occurrence and severity difficult to predict. Underlying haemostatic imbalances such as consumptive and dilutional coagulopathies may develop during PPH, and can exacerbate bleeding and lead to progression to severe PPH. Monitoring coagulation status in patients with PPH may be crucial for effective haemostatic management, goal-directed therapy, and improved outcomes. However, current PPH management guidelines do not account for the altered baseline coagulation status observed in pregnant patients, and the appropriate transfusion triggers to use in PPH are unknown, due to a lack of high-quality studies specific to this area. In this review, we consider the evidence for the use of standard laboratory-based coagulation tests and point-of-care viscoelastic coagulation monitoring in PPH. Many laboratory-based tests are unsuitable for emergency use due to their long turnaround times, so have limited value for the management of PPH. Emerging evidence suggests that viscoelastic monitoring, using thrombelastography- or thromboelastometry-based tests, may be useful for rapid assessment and for guiding haemostatic therapy during PPH. However, further studies are needed to define the ranges of reference values that should be considered ‘normal’ in this setting. Improving awareness of the correct application and interpretation of viscoelastic coagulation monitoring techniques may be critical in realizing their emergency diagnostic potential.

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Medical Emergencies in Pregnancy

Grange¹

2002

Anaesthesia for Obstetrics and Gynaecology

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Coagulation Monitoring in the Obstetric Patient

Cited by 18 publications

References 0 publications

How I treat postpartum hemorrhage

How I treat postpartum hemorrhage

Haemostatic monitoring during postpartum haemorrhage and implications for management

Medical Emergencies in Pregnancy

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