Monitoring transfusion requirements in major obstetric haemorrhage: out with the old and in with the new?

Stocks, Gary M.

doi:10.1016/j.ijoa.2011.06.011

Cited by 9 publications

(4 citation statements)

References 20 publications

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“…ROTEM®) bzw. graphie (TEG®) hat aus diesem Grund an Bedeutung gewonnen[55]. Diese Untersuchungen können im Kliniklabor durchgeführt werden, und ei ne einfache Verbindung ("virtual network computing", VNC) erlaubt es, die entspre chenden Kurven am Behandlungsort on line zu verfolgen.…”

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Management der postpartalen Blutung (PPH)

et al. 2014

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Postpartum hemorrhage (PPH) is one of the main causes of maternal deaths even in industrialized countries. It represents an emergency situation which necessitates a rapid decision and in particular an exact diagnosis and root cause analysis in order to initiate the correct therapeutic measures in an interdisciplinary cooperation. In addition to established guidelines, the benefits of standardized therapy algorithms have been demonstrated. A therapy algorithm for the obstetric emergency of postpartum hemorrhage in the German language is not yet available. The establishment of an international (Germany, Austria and Switzerland D-A-CH) "treatment algorithm for postpartum hemorrhage" was an interdisciplinary project based on the guidelines of the corresponding specialist societies (anesthesia and intensive care medicine and obstetrics) in the three countries as well as comparable international algorithms for therapy of PPH.The obstetrics and anesthesiology personnel must possess sufficient expertise for emergency situations despite lower case numbers. The rarity of occurrence for individual patients and the life-threatening situation necessitate a structured approach according to predetermined treatment algorithms. This can then be carried out according to the established algorithm. Furthermore, this algorithm presents the opportunity to train for emergency situations in an interdisciplinary team.

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Management der postpartalen Blutung (PPH)

et al. 2014

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“…Use of a POC test, such as a VET, may provide early warning regarding hemodynamic collapse from coagulopathic etiologies such as DIC. POC assays can be used for the determination of coagulation factor deficiencies, fibrinogen dysfunction, platelet impairment, and elevated fibrinolysis [24,27,33,34]. Because these tests are POC, they can be followed serially.…”

Section: Assessment and Treatment Strategies Of Severe Pphmentioning

confidence: 99%

The Utilization of Viscoelastic Testing to Guide Blood Component Therapy and Adjunctive Hemostatic Therapy for Postpartum Hemorrhage: A Narrative Review

Shariff

Lune

et al. 2019

COGO

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This narrative review discusses the history of the pathophysiologic principles and utilization of point-of-care (POC) viscoelastic tests (VETs) in the definition and treatment of postpartum hemorrhage (PPH). This paper addresses the epidemiology of PPH, describes the hemostatic changes that occur in pregnancy and in PPH, and demonstrates the utilization of viscoelastic testing in the identification and treatment of patients with PPH. Additionally, a description of rotational thromboelastometry (ROTEM) and thromboelastography (TEG), the two most commonly used VETs, is detailed in this paper. VETs have only recently been used to guide blood component therapy (BCT) in trauma in the last decade. The recent increased utilization of VETs to guide BCT in PPH is following a similar trend with a delay of ten years. In a similar fashion to the trauma literature, which expanded greatly within this last decade, the literature concerning the use of VETs in PPH has also increased in the last few years. However, because of differing pathophysiologies associated with the coagulopathy of PPH verses traumatic-induced coagulopathy (TIC), utilization of VETs has been more refined and focused on the VETs’ capacity to determine low fibrinogen and to guide the utilization of blood components and prohemostatic agents. The identification and treatment of PPH depends on clinical parameters, conventional coagulation tests (CCTs) including Clauss fibrinogen, and VETs. Successful treatment of PPH will no doubt include utilization of all three strategies with an increasing utilization of VETs in the future.

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“…Furthermore, since VHAs are point-of-care (POC) tests, they can be followed serially at the patient's bedside in labor and delivery room, operating room, and in the emergency department for precipitous emergency cesarian section such as abruptio placentae [30]. Although these tests have clear value for monitoring hemostasis, VHAs are chronically underused because of a local variability of pipetting technique in non-cartridge forms of TEG and ROTEM, standardization of parameters as well as a lack of large clinical trials demonstrating benefit [31][32][33].…”

Section: Introductionmentioning

confidence: 99%

Viscoelastic Hemostatic Assays for Postpartum Hemorrhage

Liew-Spilger

Sorg

Brenner

et al. 2021

JCM

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This article discusses the importance and effectiveness of viscoelastic hemostatic assays (VHAs) in assessing hemostatic competence and guiding blood component therapy (BCT) in patients with postpartum hemorrhage (PPH). In recent years, VHAs such as thromboelastography and rotational thromboelastometry have increasingly been used to guide BCT, hemostatic adjunctive therapy and prohemostatic agents in PPH. The three pillars of identifying hemostatic competence include clinical observation, common coagulation tests, and VHAs. VHAs are advantageous because they assess the cumulative contribution of all components of the blood throughout the entire formation of a clot, have fast turnaround times, and are point-of-care tests that can be followed serially. Despite these advantages, VHAs are underused due to poor understanding of correct technique and result interpretation, a paucity of widespread standardization, and a lack of large clinical trials. These VHAs can also be used in cases of uterine atony, preeclampsia, acute fatty liver of pregnancy, amniotic fluid embolism, placental abruption, genital tract trauma, surgical trauma, and inherited and prepartum acquired coagulopathies. There exists an immediate need for a point-of-care test that can equip obstetricians with rapid results on developing coagulopathic states. The use of VHAs in predicting and treating PPH, although in an incipient state, can fulfill this need.

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Monitoring transfusion requirements in major obstetric haemorrhage: out with the old and in with the new?

Cited by 9 publications

References 20 publications

Management der postpartalen Blutung (PPH)

Management der postpartalen Blutung (PPH)

The Utilization of Viscoelastic Testing to Guide Blood Component Therapy and Adjunctive Hemostatic Therapy for Postpartum Hemorrhage: A Narrative Review

Viscoelastic Hemostatic Assays for Postpartum Hemorrhage

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