Implementation of the D-A-CH postpartum haemorrhage algorithm after severe postpartum bleeding accelerates clinical management: A retrospective case series

Ries, Jean-Jacques; Jeker, Lena; Neuhaus, M.; Vogt, Deborah R; Girard, Thierry; Hoesli, Irène

doi:10.1016/j.ejogrb.2020.01.001

Cited by 8 publications

(10 citation statements)

References 19 publications

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“…1741 ml; p = 0.550) [43]. Taken together, these studies may reflect the potential utility of VHA devices in ruling out and identifying coagulation deficits.…”

Section: Algorithmsmentioning

confidence: 75%

“…Algorithm‐guided treatment has also allowed faster clinical management of severe postpartum bleeding [43]. The introduction of VHAs in obstetric haemorrhage may be cost effective.…”

Section: Resultsmentioning

confidence: 99%

“…One study also reported significantly lower overall estimated blood loss in patients treated via a VHA‐guided algorithm compared with those treated without the algorithm (median [IQR] 2000 ml [1600–2500] vs. 3000 ml [2000–4000]; p < 0.001) [44]. However, another study reported no difference in blood loss (mean 1706 ml vs. 1741 ml; p = 0.550) [43]. Taken together, these studies may reflect the potential utility of VHA devices in ruling out and identifying coagulation deficits.…”

Section: Resultsmentioning

confidence: 99%

“…Eleven of the 25 articles identified demonstrated VHA device utility to monitor coagulation status and guide PPH therapy [14,33,34,[39][40][41][42][43][44][45][46]. Eight publications discussed the use of VHA devices to determine VHA reference ranges in healthy pregnant women [3,[47][48][49][50][51][52][53] and six examined VHA device utility to assess PPH risk before delivery [12,[54][55][56][57][58].…”

Section: Methodsmentioning

confidence: 99%

“…Algorithm-guided treatment has also allowed faster clinical management of severe postpartum bleeding [43].…”

Section: Algorithmsmentioning

confidence: 99%

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Viscoelastic haemostatic point‐of‐care assays in the management of postpartum haemorrhage: a narrative review

et al. 2022

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Summary Viscoelastic haemostatic assays provide rapid testing at the bed‐side that identify all phases of haemostasis, from initial fibrin formation to clot lysis. In obstetric patients, altered haemostasis is common as pregnancy is associated with coagulation changes that may contribute to bleeding events such as postpartum haemorrhage, as well as thrombosis events. In this narrative review, we examine the potential clinical utility of viscoelastic haemostatic assays in postpartum haemorrhage and consider the current recommendations for their use in obstetric patients. We discuss the clinical benefits associated with the use of viscoelastic haemostatic assays due to the provision of (near) real‐time readouts with a short turnaround, coupled with the identification of coagulation defects such as hypofibrinogenaemia. The use of viscoelastic haemostatic assay‐guided algorithms may be beneficial to diagnose coagulopathy, predict postpartum haemorrhage, reduce transfusion requirements and monitor fibrinolysis in women with obstetric haemorrhage. Further studies are required to assess whether viscoelastic haemostatic assay‐guided treatment improves clinical outcomes, and to confirm the utility of prepartum viscoelastic haemostatic assay measurements for identifying patients at risk of postpartum haemorrhage.

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“…1741 ml; p = 0.550) [43]. Taken together, these studies may reflect the potential utility of VHA devices in ruling out and identifying coagulation deficits.…”

Section: Algorithmsmentioning

confidence: 75%

“…Algorithm‐guided treatment has also allowed faster clinical management of severe postpartum bleeding [43]. The introduction of VHAs in obstetric haemorrhage may be cost effective.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Algorithm-guided treatment has also allowed faster clinical management of severe postpartum bleeding [43].…”

Section: Algorithmsmentioning

confidence: 99%

See 3 more Smart Citations

Viscoelastic haemostatic point‐of‐care assays in the management of postpartum haemorrhage: a narrative review

et al. 2022

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Interdisciplinary training programs in obstetrics

et al. 2023

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ZusammenfassungEine geburtshilfliche Simulation gibt den Teilnehmenden die Möglichkeit, realitätsnah klinische Szenarien durchzuspielen und sowohl technische als auch „non technical skills“ im Team zu trainieren. Die anschließende Nachbesprechung evaluiert die Simulation. Mit zunehmender Verunsicherung im Ausführen geburtshilflicher Manöver durch fehlende praktische Erfahrung und Angst vor Verantwortung können Aufbau und Erhalt von Simulationstrainings auch einen attraktiven neuen Weg darstellen, das Interesse für die Geburtshilfe zu stärken und zu fördern. Bisher zeigten sich positive Ergebnisse in der Zufriedenheit der Teilnehmenden, in der Gewinnung von Sicherheit beim Durchführen der Manöver, in der Verbesserung der interdisziplinären Teamarbeit und im klinischen Outcome. Die Durchführung der Simulationen ist kosten- und zeitintensiv; Teamwork und Kommunikation lassen sich nur im interdisziplinären und interprofessionellen Setting (Hebammen, Geburtshelfer/innen, Anästhesisten/innen) trainieren. Grundvoraussetzungen der Simulation sind Unterstützung durch die Klinikleitung, Motivation der Teilnehmenden und in Debriefingverfahren geschulte Trainer.

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The Role of Thromboelastography during the Management of Postpartum Hemorrhage: Background, Evidence, and Practical Application

Collis

Bell

2022

Semin Thromb Hemost

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Postpartum hemorrhage (PPH) is a common cause of significant maternal morbidity and mortality that can be associated with coagulopathy, especially hypofibrinogenemia. There is interest in point-of-care viscoelastic hemostatic assays (POC-VHA) in PPH because prompt knowledge of coagulation status can aid diagnosis, identify cases of severe coagulopathy, and allow ongoing monitoring during rapid bleeding. The incidence of coagulopathy in most cases of PPH is low because of the procoagulant state of pregnancy, including raised fibrinogen levels of around 4 to 6 g/L. A Clauss fibrinogen of >2 g/L or POC-VHA equivalent has been found to be adequate for hemostasis during PPH. POC-VHA has been used successfully to diagnose hypofibrinogenemia (Clauss fibrinogen of ≤2 g/L) and guide fibrinogen treatment which has reduced bleed size and complications of massive transfusion. There are uncertainties about the use of POC-VHA to direct fresh frozen plasma and platelet administration during PPH. Several POC-VHA algorithms have been used successfully incorporated in the management of many thousands of PPHs and clinicians report that they are easy to use, interpret, and aid decision making. Due to the relative cost of POC-VHA and lack of definitive data on improving outcomes, these devices have not been universally adopted during PPH.

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Implementation of the D-A-CH postpartum haemorrhage algorithm after severe postpartum bleeding accelerates clinical management: A retrospective case series

Cited by 8 publications

References 19 publications

Viscoelastic haemostatic point‐of‐care assays in the management of postpartum haemorrhage: a narrative review

Viscoelastic haemostatic point‐of‐care assays in the management of postpartum haemorrhage: a narrative review

Interdisciplinary training programs in obstetrics

The Role of Thromboelastography during the Management of Postpartum Hemorrhage: Background, Evidence, and Practical Application

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