Point‐of‐care coagulation testing in obstetrics: more evidence, please?

Drife, J

doi:10.1111/1471-0528.16111

Cited by 4 publications

(7 citation statements)

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“…30 Well-conducted prospective studies are still needed to examine whether the use of thromboelastography or rotational thromboelastometry improves outcomes in the setting of obstetric hemorrhage. 27 Serious causes of obstetric hemorrhage are placental abruption and postpartum hemorrhage due to uterine atony, placenta accreta spectrum disorder, and ruptured uterus. Examples of rotational thromboelastometry results are shown for some of these obstetric complications in Figure 5A and B and Figure 6.…”

Section: Use In Management Of Blood Product Transfusionmentioning

confidence: 99%

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Point-of-Care Viscoelastic Tests in the Management of Obstetric Hemorrhage

Nelson¹,

Ogunkua²,

Cunningham³

2022

Obstetrics &Amp; Gynecology

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Obstetric hemorrhage remains the leading cause of maternal morbidity and mortality worldwide. Thromboelastography and rotational thromboelastometry are laboratory methods of assessing the kinetics of blood clot formation through real-time measurement of viscoelastic clot strength and may aid in management of severe hemorrhage. Although first described more than 70 years ago, viscoelastic testing devices are now available that allow for rapid point-of-care use of this technology to aid in real-time management of blood product replacement in cases of severe hemorrhage. These devices can be used to visually estimate multiple facets of hemostasis—coagulation, platelet function, and fibrinolysis—within 10–20 minutes. They have been used successfully in cardiac surgery, trauma, and liver transplantation and have potential for use in management of obstetric hemorrhage. Goals with their use include targeted transfusion of blood and its components for specific coagulation deficiencies. To date, however, published experiences with the use of these viscoelastic tests for obstetric hemorrhage have been limited. Because of the increasing use of the point-of-care tests by anesthesiologists, surgeons, and intensivists, the purpose of this report is to familiarize obstetricians with the technology involved and its use in severe hemorrhage complicating pregnancy.

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Section: Use In Management Of Blood Product Transfusionmentioning

confidence: 99%

Section: Use In Management Of Blood Product Transfusionmentioning

confidence: 99%

Point-of-Care Viscoelastic Tests in the Management of Obstetric Hemorrhage

Nelson¹,

Ogunkua²,

Cunningham³

2022

Obstetrics &Amp; Gynecology

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“…38 As expected, ROTEM amplitudes were higher than the manufacturer reference ranges for nonobstetric patients. The accompanying editorial 39 emphasized the need for more evidence and pointed out that many postpartum hemorrhage guidelines (including the Royal College of Obstetricians and Gynaecologists, the Obstetric Anaesthetists’ Association, and the Association of Anaesthetists of Great Britain and Ireland) recommend using point-of-care coagulation testing for hemorrhage management. However, the National Institute for Health and Care Excellence indicates that there is insufficient evidence to recommend routine viscoelastomeric testing in management of PPH, primarily because existing data on point-of-care coagulation testing had come from cardiovascular surgery and trauma management.…”

Section: General Clinical Carementioning

confidence: 99%

What Is New in Obstetric Anesthesia: The 2021 Gerard W. Ostheimer Lecture

Lim

2022

Anesthesia &Amp; Analgesia

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The Gerard W. Ostheimer lecture is given annually to members of the Society for Obstetric Anesthesia and Perinatology. This lecture summarizes new and emerging literature that informs the clinical practice of obstetric anesthesiologists. In this review, some of the most influential articles discussed in the 2021 virtual lecture are highlighted. Themes include maternal mortality; disparities and social determinants of health; cognitive function, mental health, and recovery; quality and safety; operations, value, and economics; clinical controversies and dogmas; epidemics and pandemics; fetal-neonatal and child health; general clinical care; basic and translational science; and the future of peripartum anesthetic care. Practice-changing evidence is presented and evaluated. A priority list for clinical updates, systems, and quality improvement initiatives is presented.

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“…ROTEM has been shown to safely guide transfusion of blood products in evolving PPH [13]. Normal values in pregnancy have been identified for ROTEM parameters [34][35][36]. The FIBTEM test involves a platelet inhibitor reagent which allows the contribution of fibrinogen in clot formation to be measured in isolation [31].…”

Section: Point Of Care Coagulation Testsmentioning

confidence: 99%

Blood management in post-partum haemorrhage, including point of care coagulation tests

2021

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Postpartum haemorrhage (PPH) is the leading global cause of maternal mortality, and an important cause of morbidity and mortality in the UK. Management of PPH requires a patient centred team approach to ensure effective management. Early recognition is crucial, hence quantitative measurement of blood loss should be started as soon as bleeding is identified and continue throughout an evolving haemorrhage. Pregnancy is associated with haematological changes resulting in a pro-coagulant state. Blood management in PPH has moved away from the use of shock packs and fixed transfusion ratios. Most women are not initially coagulopathic and coagulopathy is uncommon in mild to moderate PPH, Practice has therefore moved towards goal directed transfusion of blood products informed by haematological investigations alongside clinical assessment. Fibrinogen tends to be the first coagulation factor to fall and Clauss fibrinogen is an important predictor of PPH severity. Transfusion of fibrinogen rich blood products such as cryoprecipitate and fibrinogen complex are more effective at rapidly increasing fibrinogen levels compared to FFP. Point of care (POC) coagulation tests such as rotational thromboelastometry (ROTEM) and thromboeslastography (TEG) allow rapid bedside assessment compared to traditional laboratory tests. Surrogate markers of fibrinogen from POC tests can be used to both predict severity of PPH and inform blood transfusion. There is growing evidence that POC coagulation tests can be used to safely guide blood management in PPH, with its use associated with lower transfusion rates and possibly improved clinical outcomes. Further multi-centre studies are required to clarify debate surrounding their use. In this review we discuss blood management in PPH, with a focus on recent evidence regarding assessment of coagulopathy and the use of blood products.

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Point‐of‐care coagulation testing in obstetrics: more evidence, please?

Cited by 4 publications

References 0 publications

Point-of-Care Viscoelastic Tests in the Management of Obstetric Hemorrhage

Point-of-Care Viscoelastic Tests in the Management of Obstetric Hemorrhage

What Is New in Obstetric Anesthesia: The 2021 Gerard W. Ostheimer Lecture

Blood management in post-partum haemorrhage, including point of care coagulation tests

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