Changes in thromboelastography parameters in pregnancy, labor, and the immediate postpartum period

Abstract

The present study describes a novel finding regarding changes in clot mechanics in late pregnancy/puerperium and supports the concept of using thromboelastography as part of the routine assessments at delivery.

The ability of thromboelastography parameters to predict severe pre‐eclampsia when measured during early pregnancy

“…This state of hypercoagulation is attributed to a slowdown in blood flow; decreased activity of protein S; increased levels of some coagulation factors (e.g. factor VII, factor VIII, von Willebrand factor, and fibrinogen); and increased prothrombin activity …”

“…factor VII, factor VIII, von Willebrand factor, and fibrinogen); and increased prothrombin activity. 23 The present study used previously published reference ranges 11…”

Baseline parameters for rotational thromboelastometry (ROTEM®) in healthy pregnant Australian women: a comparison of labouring and non-labouring women at term

“…1,2 Women become more hypercoagulable as pregnancy progresses through the three trimesters and this has been measured by both thromboelastography and rotational thromboelastometry in uncomplicated pregnancies. 3 To date there has been a paucity of substantial, well-researched reference ranges for ROTEM Ò in pregnant labouring and non-labouring women. The increasing utilisation of point-of-care coagulation testing for obstetric patients warrants proper validation of hypercoagulable changes demonstrated by ROTEM Ò .…”

“…Changes consistent with clotting activation occur during normal vaginal delivery. [3][4][5] During labour, a hypercoagulable state is accompanied by enhanced fibrinolysis and platelet activation, along with elevated fibrinogen, plasminogen activator inhibitor-1 and -2 levels, and decreased total protein S and antithrombin III activity. 6 Activation of the fibrinolytic system begins during labour, prior to placental separation, as compensation for the hypercoagulable state of pregnancy.…”

“…[12][13][14][15][16] From the time of active labour to the postpartum period, comparison of visco-elastic testing demonstrated a dynamic shift from maximum clot formation to increased clot lysis. 3 The current study aimed to compare mean values of ROTEM Ò baseline parameters for labouring women to those established for nonlabouring women who had presented for elective caesarean delivery at term gestation.…”