Clinical Value of Early Viscoelastometric Point-of-Care Testing During Postpartum Hemorrhage for the Prediction of Severity of Bleeding; A Multicenter Prospective Cohort Study in the Netherlands

Abstract

(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.

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

“…However, it is not known whether a low fibrinogen level per se, or a low fibrin-based clot firmness, causes progression of PPH or reflects the severity of the bleed and the resuscitation effort required 830 . Fibrinogen level or VHA measurements are associated with severe PPH, but remain poor stand-alone predictors 832 . Evaluation of fibrinogen at the onset of labour is of less predictive value 833–836 .…”

“…830 Fibrinogen level or VHA measurements are associated with severe PPH, but remain poor stand-alone predictors. 832 Evaluation of fibrinogen at the onset of labour is of less predictive value. [833][834][835][836] During rare cases of amniotic fluid embolism with disseminated intravascular coagulation, 837 placental abruption 838 or preeclampsia with haemorrhage, fibrinogen measurements are of important value.…”

Clinical Value of Early Assessment of Hyperfibrinolysis by Rotational Thromboelastometry During Postpartum Hemorrhage for the Prediction of Severity of Bleeding: A Multicenter Prospective Cohort Study in the Netherlands

“…This study was a secondary analysis of the Towards better prognostic and diagnostic strategies for hemostatic changes during Major Obstetric Hemorrhage (TeMpOH-2) study. 11,12 The TeMpOH-2 study was a multicenter prospective cohort study in the Netherlands between February 2015 and April 2018. Pregnant women were recruited at outpatient clinics and maternity wards of three participating hospitals: Leiden University Medical Center (university hospital), Erasmus Medical Centre (university hospital), and Isala Clinics Zwolle (nonuniversity teaching hospital).…”

“…12 ROTEM results were intended to be blinded to the clinicians and women were treated according to the Dutch national guideline for the management of PPH. 11,13 When bleeding ceased before reaching the threshold of 1000 ml blood loss, these specific samples were excluded from analysis. When multiple blood samples were drawn, the first sample above or closest to 1000 ml was selected for analysis, as advised by the Dutch and English national PPH management guidelines.…”