(Acta Obstet Gynecol Scand. 2021;100:1656–1664) Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide. Early intervention before the development of coagulopathy can reduce hemostatic impairments, preventing the need for interventions including hysterectomy and massive blood transfusion. Tests currently used during PPH to evaluate clotting status include the FIBTEM and fibrinogen measurement. Results from these tests unfortunately can take up to an hour, during which time significant blood may be lost. Results of clot firmness from FIBTEM at 5 minutes (A5 measurement) can indicate the potential for PPH in only 15 minutes. In this multicenter study in the Netherlands researchers compared blood loss within 24 hours of birth to the results of these tests to determine accuracy in predicting severe PPH with blood loss ≥2000 mL.

(Acta Obstet Gynecol Scand. 2022;101:145–152. doi: 10.1111/aogs.14279) Rotational thromboelastometry (ROTEM) provides point-of-care technology for detecting hyperfibrinolysis, a condition that can precede coagulopathy and lead to excessive bleeding with childbirth. Early awareness of the contribution of hyperfibrinolysis to postpartum hemorrhage (PPH) allows for targeted anti-fibrinolytic treatment that can reduce the risk of severe bleeding. This study investigates the efficacy of ROTEM for predicting the development of excessive blood loss by timely detection of hyperfibrinolysis at the earliest stages of PPH.