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

Nelson, David B.; Ogunkua, Olutoyosi; Cunningham, F. Gary

doi:10.1097/aog.0000000000004686

Cited by 11 publications

(6 citation statements)

References 37 publications

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“…The authors of a recent clinical expert series in obstetrics and gynecology identified the utility of POC testing with TEG in PPH but noted that published data in the obstetrics literature were lacking. 17 Our study adds to the growing body of evidence to support the use of TEG for targeted resuscitation in ongoing PPH.…”

Section: Discussionmentioning

confidence: 70%

Thromboelastography versus Standard Coagulation Assays in Patients with Postpartum Hemorrhage

et al. 2022

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Key words: postpartum hemorrhage, thromboelastography, coagulopathy, fibrinogen, massive transfusion. Objective: Thromboelastography, a point-of-care test that measures blood’s dynamic viscoelastic properties, is routinely used to guide resuscitation in surgical specialties with high hemorrhage risk. Patients with ongoing postpartum hemorrhage often develop coagulopathy and hypofibrinogenemia. Timely assessment of fibrinogen is crucial because cryoprecipitate for repletion requires thawing prior to administration. Thromboelastography may provide rapid assessment of coagulopathy in ongoing hemorrhage but this has not been thoroughly studied. Our objective was to determine if thromboelastography accurately reflects coagulopathy in ongoing postpartum hemorrhage when compared to standard assays. Study Design: This was a retrospective cohort study of people with ongoing postpartum hemorrhage (quantified blood loss >1000 mL), from 1/1/16-12/31/19. Thromboelastography variables and standard coagulation parameters were compared in patients who had both assays drawn simultaneously. As a secondary analysis, patients who had thromboelastography were compared to those who did not. Mann-Whitney, Fisher’s Exact, Kruskal-Wallis, Spearman’s Rho, and logistic regression tests were used for analysis. Significance was set at p < 0.05. Results: A total of 680 patients were included. 69 had thromboelastography and coagulation parameters drawn simultaneously and were included in the primary analysis. The remainder were included in the secondary analysis. Thromboelastography variables and coagulation assays correlated significantly - prolonged R with increased PTT (rho 0.25, p=0.04), prolonged K and decreased alpha angle with decreased fibrinogen (rho -0.61, p<0.001; rho 0.24, p<0.001), and decreased maximum amplitude with decreased platelets (rho 0.62, p<0.001). Those who had thromboelastographic assays had higher blood loss and need for interventions to manage hemorrhage than those who did not. Conclusion: Thromboelastography correlated significantly with standard laboratory assays in ongoing postpartum hemorrhage, including for patients with hypofibrinogenemia Given the point-of-care nature and rapid turnaround time, thromboelastography should be considered for timely hemorrhage evaluation and directed resuscitation of coagulopathy.

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Section: Discussionmentioning

confidence: 70%

Thromboelastography versus Standard Coagulation Assays in Patients with Postpartum Hemorrhage

et al. 2022

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“…Gemelli's pregnancy is thought to be able to trigger severe preeclampsia because it causes hyperplacentosis. Hyperplacentosis is believed to increase antiangiogenic levels circulating in the maternal circulation, affecting the balance of angiogenic and antiangiogenic factors (Nelson, Ogunkua, & Cunningham, 2022).…”

Section: Resultsmentioning

confidence: 99%

Preeclampsia in Multiples: A Comparative Case Study on Dichorionic-Diamniotic Twin Pregnancy

Putri Arifin,

Rustiani,

Firmansyah

2024

jist

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Multiple pregnancies have a 2-3 times greater risk of developing preeclampsia and have a significant long-term effect on both mothers and babies. The underlying cause of preeclampsia in women with multiple pregnancies is higher demand on the cardiovascular system, increased exposure of the chorionic villi, increased antiangiogenic substances compared to angiogenic substances and placental hypoperfusion. The condition of preeclampsia can worsen quickly, and without warning signs, it must be detected and managed appropriately; if the treatment is late, this condition can lead to eclampsia. The patient was referred with severe preeclampsia and multiple pregnancies with complaints of irregular contraction (+), a history of dizziness (-), nausea (-), vomiting (-), blurred vision (-), and breathlessness (-). Physical examination showed Blood pressure 188/125 mmHg with laboratory findings of proteinuria +3. Cesarean section and IUD insertion were performed. During and after surgery, there were no complications.

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“…In recent years there has been increasing use of point-of-care viscoelastic haemostatic assay-guided blood product transfusion [ 48 ]. In an evaluation of a national quality improvement project in Wales including this technology, there were no deaths from haemorrhage among 60,914 maternities [ 49 ].…”

Section: Point-of-care Viscoelastic Haemostatic Assay-guided Blood Pr...mentioning

confidence: 99%

Novel concepts and improvisation for treating postpartum haemorrhage: a narrative review of emerging techniques

Hofmeyr¹

2023

Reprod Health

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Background Most treatments for postpartum haemorrhage (PPH) lack evidence of effectiveness. New innovations are ubiquitous but have not been synthesized for ready access. Narrative review Pubmed 2020 to 2021 was searched on ‘postpartum haemorrhage treatment’, and novel reports among 755 citations were catalogued. New health care strategies included early diagnosis with a bundled first response and home-based treatment of PPH. A calibrated postpartum blood monitoring tray has been described. Oxytocin is more effective than misoprostol; addition of misoprostol to oxytocin does not improve treatment. Heat stable carbetocin has not been assessed for treatment. A thermostable microneedle oxytocin patch has been developed. Intravenous tranexamic acid reduces mortality but deaths have been reported from inadvertent intrathecal injection. New transvaginal uterine artery clamps have been described. Novel approaches to uterine balloon tamponade include improvised and purpose-designed free-flow (as opposed to fixed volume) devices and vaginal balloon tamponade. Uterine suction tamponade methods include purpose-designed and improvised devices. Restrictive fluid resuscitation, massive transfusion protocols, fibrinogen use, early cryopreciptate transfusion and point-of-care viscoelastic haemostatic assay-guided blood product transfusion have been reported. Pelvic artery embolization and endovascular balloon occlusion of the aorta and pelvic arteries are used where available. External aortic compression and direct compression of the aorta during laparotomy or aortic clamping (such as with the Paily clamp) are alternatives. Transvaginal haemostatic ligation and compression sutures, placental site sutures and a variety of novel compression sutures have been reported. These include Esike’s technique, three vertical compression sutures, vertical plus horizontal compression sutures, parallel loop binding compression sutures, uterine isthmus vertical compression sutures, isthmic circumferential suture, circumferential compression sutures with intrauterine balloon, King’s combined uterine suture and removable retropubic uterine compression suture. Innovative measures for placenta accreta spectrum include a lower uterine folding suture, a modified cervical inversion technique, bilateral uterine artery ligation with myometrial excision of the adherent placenta and cervico-isthmic sutures or a T-shaped lower segment repair. Technological advances include cell salvage, high frequency focussed ultrasound for placenta increta and extra-corporeal membrane oxygenation. Conclusions Knowledge of innovative methods can equip clinicians with last-resort options when faced with haemorrhage unresponsive to conventional methods.

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

Cited by 11 publications

References 37 publications

Thromboelastography versus Standard Coagulation Assays in Patients with Postpartum Hemorrhage

Thromboelastography versus Standard Coagulation Assays in Patients with Postpartum Hemorrhage

Preeclampsia in Multiples: A Comparative Case Study on Dichorionic-Diamniotic Twin Pregnancy

Novel concepts and improvisation for treating postpartum haemorrhage: a narrative review of emerging techniques

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